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Thyroid Storm in the ICU: A Retrospective Multicenter Study.

Simon Bourcier1, Maxime Coutrot1, Antoine Kimmoun2

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Severe thyroid storm requiring intensive care unit (ICU) admission has high mortality. Early cardiogenic shock and organ failure significantly worsen prognosis, highlighting the need for prompt, aggressive management of this endocrine emergency.

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Area of Science:

  • Endocrinology
  • Critical Care Medicine

Background:

  • Thyroid storm is a rare, life-threatening endocrine emergency with limited data on severe cases requiring intensive care unit (ICU) admission.
  • Understanding the clinical course, management, and outcomes of these critical patients is essential for improving survival rates.

Purpose of the Study:

  • To describe the clinical features, management strategies, and in-ICU and 6-month survival rates for patients experiencing severe thyroid storm necessitating ICU admission.

Main Methods:

  • A retrospective, multicenter, national study was conducted over 18 years (2000-2017) across 31 French ICUs.
  • Medical records of 92 patients meeting criteria for definite thyroid storm with at least one organ failure were analyzed.

Main Results:

  • The primary causes of thyroid storm were amiodarone-associated thyrotoxicosis (33%) and Graves' disease (26%).
  • Thirty-eight percent of patients developed cardiogenic shock within 48 hours of ICU admission.
  • In-ICU and 6-month mortality rates were 17% and 22%, respectively. Nonsurvivors required more intensive interventions, including vasopressors and extracorporeal membrane oxygenation.

Conclusions:

  • Thyroid storm requiring ICU admission is associated with substantial in-ICU mortality.
  • Early cardiogenic shock and Sequential Organ Failure Assessment score (excluding cardiovascular component) are independent predictors of in-ICU mortality.
  • Prompt identification and aggressive management are crucial for improving outcomes in severe thyroid storm.