High risk and low prevalence diseases: Thyroid storm.

Area of Science:

• Endocrinology
• Emergency Medicine

Background:

• Thyroid storm is a rare but critical condition with high morbidity and mortality.
• It presents with exaggerated thyrotoxicosis symptoms and multiorgan dysfunction, often triggered by an event.

Purpose of the Study:

• To review the presentation, diagnosis, and management of thyroid storm in the emergency department (ED).
• To highlight critical aspects for emergency clinicians in managing this condition.

Main Methods:

• Review of current evidence on thyroid storm diagnosis and management.
• Discussion of clinical features, diagnostic criteria (Burch-Wartofsky, Japan Thyroid Association), and differential diagnoses.
• Outline of ED treatment protocols including supportive care and specific medications.

Main Results:

• Thyroid storm diagnosis relies on clinical suspicion and criteria, as no single lab test is definitive.
• Mimics include sepsis, serotonin syndrome, and sympathomimetic overdose.
• ED management involves trigger identification, resuscitation, steroids, thionamides, iodine, cholestyramine, and hyperthermia control.

Conclusions:

• Early recognition and understanding of thyroid storm are crucial for emergency clinicians.
• A multidisciplinary approach involving critical care and endocrinology is essential for optimal management.