title: 2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition).
abstract: Thyroid storm is an endocrine emergency which is characterized by multiple organ failure due to severe thyrotoxicosis, often associated with triggering illnesses. Early suspicion, prompt diagnosis and intensive treatment will improve survival in thyroid storm patients. Because of its rarity and high mortality, prospective intervention studies for the treatment of thyroid storm are difficult to carry out. We, the Japan Thyroid Association and Japan Endocrine Society taskforce committee, previously developed new diagnostic criteria and conducted nationwide surveys for thyroid storm in Japan. Detailed analyses of clinical data from 356 patients revealed that the mortality in Japan was still high (∼11%) and that multiple organ failure and acute heart failure were common causes of death. In addition, multimodal treatment with antithyroid drugs, inorganic iodide, corticosteroids and beta-adrenergic antagonists has been suggested to improve mortality of these patients. Based on the evidence obtained by nationwide surveys and additional literature searches, we herein established clinical guidelines for the management of thyroid storm. The present guideline includes 15 recommendations for the treatment of thyrotoxicosis and organ failure in the central nervous system, cardiovascular system, and hepato-gastrointestinal tract, admission criteria for the intensive care unit, and prognostic evaluation. We also proposed preventive approaches to thyroid storm, roles of definitive therapy, and future prospective trial plans for the treatment of thyroid storm. We hope that this guideline will be useful for many physicians all over the world as well as in Japan in the management of thyroid storm and the improvement of its outcome.
authors.affiliation: Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Gunma 371-8511, Japan.
authors.forename: Tetsurou
authors.initials: T
authors.lastname: Satoh
authors.forename: Osamu
authors.initials: O
authors.lastname: Isozaki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Suzuki
authors.forename: Shu
authors.initials: S
authors.lastname: Wakino
authors.forename: Tadao
authors.initials: T
authors.lastname: Iburi
authors.forename: Kumiko
authors.initials: K
authors.lastname: Tsuboi
authors.forename: Naotetsu
authors.initials: N
authors.lastname: Kanamoto
authors.forename: Hajime
authors.initials: H
authors.lastname: Otani
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Furukawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teramukai
authors.forename: Takashi
authors.initials: T
authors.lastname: Akamizu
mesh_terms: D013956:Antithyroid Agents / Q000627:therapeutic use; D001831:Body Temperature; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D004704:Endocrinology / Q000458:organization & administration / Q000592:standards*; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D007564:Japan; D009102:Multiple Organ Failure / Q000150:complications / Q000628:therapy; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D011379:Prognosis; D012955:Societies, Medical / Q000592:standards; D013958:Thyroid Crisis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D013971:Thyrotoxicosis / Q000150:complications / Q000628:therapy
chemical_list: D013956:Antithyroid Agents