542:. Multiple approaches have been proposed to calculate the probability of thyroid storm based on clinical criteria, however, none have been universally adopted by clinicians. For instance, Burch and Wartofsky published the Burch-Wartofsky point scale (BWPS) in 1993, assigning a numerical value based on the presence of specific signs and symptoms organized within the following categories: temperature, cardiovascular dysfunction (including heart rate and presence of atrial fibrillation or congestive heart failure), central nervous system (CNS) dysfunction, gastrointestinal or liver dysfunction and presence of a precipitating event. A Burch-Wartofsky score below 25 is not suggestive of thyroid storm whereas 25 to 45 suggests impending thyroid storm and greater than 45 suggests current thyroid storm. Alternatively, the Japanese Thyroid Association (JTA) criteria, derived from a large cohort of patients with thyroid storm in Japan and published in 2012, provide a qualitative method to determine the probability of thyroid storm. The
52:
403:
1038:
corticosteroids (hydrocortisone and dexamethasone are preferred over prednisolone or methylprednisolone) be administered to all patients with thyroid storm. However, doses should be altered for each individual patient to ensure that the relative adrenal insufficiency is adequately treated while minimizing the risk of side effects.
907:
The main strategies for the management of thyroid storm are reducing production and release of thyroid hormone, reducing the effects of thyroid hormone on tissues, replacing fluid losses, and controlling temperature. Thyroid storm requires prompt treatment and hospitalization. Often, admission to the
1028:
at high doses is a common first-line treatment, as it reduces peripheral conversion of T4 to T3, which is the more active form of thyroid hormone. Non-selective beta blockers have been suggested to be beneficial due to their inhibitory effects on peripheral deiodinases. Some recent research suggests
849:
is suppressed. Both free and serum (or total) T3 and T4 are elevated. An elevation in thyroid hormone levels is suggestive of thyroid storm when accompanied by signs of severe hyperthyroidism but is not diagnostic as it may also correlate with uncomplicated hyperthyroidism. Moreover, serum T3 may be
1948:
Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN (June 2011). "Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the
American Thyroid Association and American Association of Clinical
1313:
Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN (June 2011). "Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the
American Thyroid Association and American Association of Clinical
413:
may be free (biologically active T3/T4) or bound to thyroid binding hormone (biologically inactive) for transport. The release of thyroid hormone is tightly regulated by a feedback system involving the hypothalamus, pituitary gland, and thyroid gland. Hyperthyroidism results from a dysregulation of
426:
Individuals with thyroid storm tend to have increased levels of free thyroid hormone, although total thyroid hormone levels may not be much higher than in uncomplicated hyperthyroidism. The rise in the availability of free thyroid hormone can be the result of manipulating the thyroid gland. In an
1037:
High levels of thyroid hormone result in a hypermetabolic state, which can result in increased breakdown of cortisol, a hormone produced by the adrenal gland. This results in a state of relative adrenal insufficiency, in which the amount of cortisol is not sufficient. Guidelines recommend that
161:
may occur. Death may occur despite treatment. Most episodes occur either in those with known hyperthyroidism whose treatment has stopped or become ineffective, or in those with untreated mild hyperthyroidism who have developed an intercurrent illness (such as an infection).
184:, thyroid storm has a mortality rate of up to 25% despite treatment. Without treatment, the condition is typically fatal, with a mortality rate of 80-100%. Historically, the condition was considered untreatable, with hospital mortality rates approaching 100%.
963:. Some guidelines recommend that iodine be administered after antithyroid medications are started, because iodine is also a substrate for the synthesis of thyroid hormone, and may worsen hyperthyroidism if administered without antithyroid medications.
2248:"Treatment and management of thyroid storm: analysis of the nationwide surveys: The taskforce committee of the Japan Thyroid Association and Japan Endocrine Society for the establishment of diagnostic criteria and nationwide surveys for thyroid storm"
2461:
979:) are used to reduce the synthesis and release of thyroid hormone. Propylthiouracil is preferred over methimazole due to its additional effects on reducing peripheral conversion of T4 to T3, however both are commonly used. If the
455:
activation during times of stress may also play a significant role in thyroid storm. Sympathetic activation increases production of thyroid hormone by the thyroid gland. In the setting of elevated thyroid hormone, the density of
246:. Individuals are at higher risk of thyroid storm if their hyperthyroidism is incompletely treated or if their anti-thyroid drugs are discontinued. Many of these individuals have underlying primary causes of hyperthyroidism (
503:) thyroid function is tuned down to result in low-T3 syndrome and, occasionally, also low TSH concentrations, low-T4 syndrome and impaired plasma protein binding of thyroid hormones. This endocrine pattern is referred to as
443:
Along with increases in thyroid hormone availability, it is suggested that thyroid storm is characterized by the body's heightened sensitivity to thyroid hormone, which may be related to sympathetic activation.
262:). However, thyroid storm can occur in individuals with unrecognized thyrotoxicosis experiencing non-thyroid surgery, labor, infection, or exposure to certain medications and radiocontrast dyes.
414:
this system that eventually leads to increases in levels of free T3/T4. The transition from simple hyperthyroidism to the medical emergency of thyroid storm can be triggered by conditions (
519:). In cases where critical illness is accompanied by thyrotoxicosis, this comorbidity prevents the down-regulation of thyroid function. Therefore, the consumption of energy, oxygen and
196:, restlessness, agitation) accompanied by other features such as fever (temperatures often above 40 °C/104 °F), hypertension, mental status changes, diarrhea, and vomiting.
931:/acetaminophen and external cooling measures (cool blankets, ice packs). Dehydration, which occurs due to fluid loss from sweating, diarrhea, and vomiting, is treated with frequent
530:
These newer theories imply that thyroid storm results from an interaction of thyrotoxicosis with the specific response of the organism to an oversupply of thyroid hormones.
546:
separate the diagnosis of thyroid storm into definite versus suspected based on the specific combination of signs and symptoms a patient exhibits and require elevated free
222:
In some situations, individuals may not experience the classic signs of restlessness and agitation, but instead present with apathetic signs of weakness and confusion.
1049:
removes cytokines, antibodies, and thyroid hormones from the plasma. It is usually reserved for severe refractory cases of thyroid storm as a bridge to surgery.
427:
individual receiving radioactive iodine therapy, free thyroid hormone levels can acutely increase due to the release of hormone from ablated thyroid tissue.
2634:
2677:
2539:
1711:
468:. This is likely responsible for several of the cardiovascular symptoms (increased cardiac output, heart rate, stroke volume) seen in thyroid storm.
2184:"Cardiovascular Collapse Secondary to Beta-Blocker Administration in a Setting of Coexisting Thyroid Storm and Atrial Fibrillation: A Case Report"
2723:
2644:
1721:
1548:
1006:
and thyroid hormone recycling. Cholestyramine use is usually reserved for patients who are intolerant of the other antithyroid medications.
435:
A decrease in thyroid hormone binding protein under the effects of stressors or medications may also cause a rise in free thyroid hormone.
1070:
1742:"Thyroid Allostasis–Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming"
955:) to reduce the synthesis and release of thyroid hormone. In high dosage, iodine may reduce the synthesis of thyroid hormone via the
2699:
515:(TACITUS). Although NTIS is associated with significantly worse prognosis, it is also assumed to represent a beneficial adaptation (
259:
230:
The transition from hyperthyroidism to thyroid storm is typically triggered by a non-thyroidal insult including, but not limited to
173:) to reduce synthesis and release of thyroid hormone. Temperature control and intravenous fluids are also mainstays of management.
2802:
2246:
Isozaki O, Satoh T, Wakino S, Suzuki A, Iburi T, Tsuboi K, Kanamoto N, Otani H, Furukawa Y, Teramukai S, Akamizu T (June 2016).
850:
normal in critically ill patients due to decreased conversion of T4 to T3. Other potential abnormalities include the following:
481:
2596:
2532:
2797:
2787:
1740:
Chatzitomaris A, Hoermann R, Midgley JE, Hering S, Urban A, Dietrich B, Abood A, Klein HH, Dietrich JW (20 July 2017).
1521:
846:
177:
are often used to reduce the effects of thyroid hormone. Patients often require admission to the intensive care unit.
2295:
Muller C, Perrin P, Faller B, Richter S, Chantrel F (December 2011). "Role of plasma exchange in the thyroid storm".
2820:
2672:
877:
452:
2403:
Amos S, Pollack R, Sarig I, Rudis E, Hirshoren N, Weinberger J, Arad A, Fischer M, Talmon A, Stokar J (May 2023).
2863:
2765:
2621:
2574:
1539:
Paulson JM, Hollenberg AN (2017). "Thyroid
Emergencies". In McKean SC, Ross JJ, Dressler DD, Scheurer DB (eds.).
1003:
1073:(ECMO) can be used as a bridging measure for refractory cardiorespiratory failure induced by thyroid storm.
2898:
2525:
2476:
457:
212:
2070:"A Rare Case of Subacute Painful Thyroiditis Causing Thyroid Storm and a Successful Trial of Propylthiouracil"
1029:
them to be associated with increased mortality. Therefore, cardioselective beta blockers may be favourable.
2830:
2689:
2591:
1087:
199:
Individuals can exhibit varying signs of organ dysfunction. Patients may experience liver dysfunction, and
2825:
2814:
936:
60:
2807:
999:
885:
496:
335:
276:
208:
134:
2348:"Therapeutic Plasma Exchange as a Bridge to Total Thyroidectomy in Patients with Severe Thyrotoxicosis"
203:(yellowing of the skin), which is considered a poor prognostic sign. Cardiac (heart) symptoms include
2858:
2792:
2743:
1882:
Akamizu T, Satoh T, Isozaki O, Suzuki A, Wakino S, Iburi T, Tsuboi K, Monden T, Kouki T (July 2012).
984:
892:
538:
The diagnosis of thyroid storm is based on the presence of signs and symptoms consistent with severe
243:
1884:"Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys"
1002:
used to reduce levels of circulating thyroid hormone in thyrotoxic patients by interfering with the
484:, which would help to save energy in critical illness and other instances of high metabolic demand.
409:
The precise mechanism for the development of thyroid storm is poorly understood. In the human body,
51:
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150:
956:
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69:
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1993:
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932:
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216:
181:
40:
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2304:
2259:
2213:
2195:
2140:
2099:
2081:
2040:
2024:
1984:
Amos S (May 2023). ""VA-ECMO for
Thyroid Storm: Case Reports and Review of the Literature".
1958:
1911:
1895:
1848:
1805:
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1624:
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Nai Q, Ansari M, Pak S, Tian Y, Amzad-Hossain M, Zhang Y, Lou Y, Sen S, Islam M (2018).
543:
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2012:
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1440:
1407:
1383:
1350:
1173:
1140:
1046:
960:
866:
524:
461:
165:
The primary treatment of thyroid storm is with inorganic iodine and antithyroid drugs (
142:
103:
2013:"Subacute thyroiditis causing thyrotoxic crisis; a case report with literature review"
1852:
2892:
2586:
2308:
1839:
Burch HB, Wartofsky L (June 1993). "Life-threatening thyrotoxicosis. Thyroid storm".
1082:
1022:) is recommended to reduce the effect of circulating thyroid hormone on end organs.
1015:
995:
913:
858:
854:
465:
356:
307:
255:
154:
107:
45:
2332:
2168:
1696:
1636:
1596:
1294:
2609:
2281:
1197:"Thyroid Storm Clinical Presentation: History, Physical Examination, Complications"
1066:
1061:. Supportive measures include treatment of precipitating factors (e.g. infection),
870:
322:
283:
174:
158:
138:
2481:
192:
Thyroid storm is characterized by an acute onset of symptoms of hyperthyroidism (
2779:
2346:
Tieken K, Paramasivan AM, Goldner W, Yuil-Valdes A, Fingeret AL (January 2020).
2028:
1366:
1111:
1025:
976:
928:
520:
300:
239:
170:
146:
118:
1809:
1265:
Chiha M, Samara S, Kabaker A (March 2015). "Thyroid Storm: An
Updated Review".
1230:
1141:"Cardiorespiratory Failure in Thyroid Storm: Case Report and Literature Review"
987:, antithyroid medications are not always used, and its use is "controversial".
2470:
1580:
1217:
Klubo-Gwiezdzinska J, Wartofsky, Leonard (March 2012). "Thyroid emergencies".
1019:
516:
477:
368:
Medication side effect (anesthetics, salicylate, pseudoephedrine, amiodarone)
204:
122:
114:
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2316:
2209:
2152:
2095:
2036:
1907:
1860:
1817:
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1431:
1374:
1278:
1164:
2569:
2500:
2404:
2011:
Salih AM, Kakamad F, Rawezh Q, Masrur S, Shvan H, Hawbash M, Lhun T (2017).
881:
551:
402:
76:
2428:
2389:
2363:
2324:
2273:
2227:
2128:
2113:
2054:
1997:
1970:
1925:
1825:
1777:
1688:
1588:
1449:
1392:
1335:
1286:
1238:
1182:
1119:
927:
In high fever, temperature control is achieved with fever reducers such as
2160:
1962:
1899:
1868:
1628:
1327:
2581:
2200:
980:
200:
130:
126:
2453:
2086:
1156:
1057:
Patients with thyroid storm are usually hospitalized and managed in the
1796:
Klubo-Gwiezdzinska J, Wartofsky L (March 2012). "Thyroid emergencies".
862:
513:
thyroid allostasis in critical illness, tumours, uraemia and starvation
480:
failure in a situation where thyrotoxicosis hampers the development of
95:
2405:"VA-ECMO for Thyroid Storm: Case Reports and Review of the Literature"
2264:
2247:
2848:
2465:
1423:
492:
349:
251:
235:
65:
939:
may be necessary. Any suspected underlying cause is also addressed.
1667:
Chiha M, Samarasinghe S, Kabaker AS (2013-08-05). "Thyroid Storm".
1615:
Dietrich J (15 June 2016). "Thyreotoxische Krise und Myxödemkoma".
2614:
2517:
401:
231:
1349:
Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y (2016).
921:
2521:
1490:"Thyroid Storm: Practice Essentials, Pathophysiology, Etiology"
1408:"Acute and emergency care for thyrotoxicosis and thyroid storm"
117:(temperatures often above 40 °C / 104 °F),
2182:
Bokhari SF, Sattar H, Abid S, Vohra RR, Sajid S (2022-09-19).
2068:
Gaballa S, Hlaing KM, Bos N, Moursy S, Hakami M (2020-07-29).
81:
8-25% mortality with treatment; 80-100% mortality if untreated
947:
Guidelines recommend the administration of inorganic iodide (
681:
Moderate (e.g. diarrhea, nausea, vomiting or abdominal pain)
1105:
1103:
90:
is a rare but severe and life-threatening complication of
1464:"Gathering Storm: Treating the Once Fatal Thyroid Storm"
476:
According to newer theories, thyroid storm results from
1569:
1567:
Dietrich JW (September 2012). "Thyreotoxische Krise ".
1361:(7). Ovid Technologies (Wolters Kluwer Health): e2848.
2129:"Adjunctive cholestyramine therapy for thyrotoxicosis"
1841:
Endocrinology and
Metabolism Clinics of North America
1735:
1733:
2443:
1351:"Factors Associated With Mortality of Thyroid Storm"
2841:
2778:
2711:
2658:
2555:
2491:
2447:
2127:Solomon BL, Wartofsky L, Burman KD (January 1993).
75:
59:
39:
31:
26:
464:) also increases, which enhances the response to
1716:(4th ed.). Academic Press. pp. 52–53.
1610:
1608:
1606:
1562:
1560:
2241:
2239:
2237:
523:remains high, which leads to further increased
717:Moderate (e.g. delirium, psychosis, lethargy)
2533:
2017:International Journal of Surgery Case Reports
8:
2409:The Israel Medical Association Journal: IMAJ
1541:Principles and Practice of Hospital Medicine
1526:Greenspan's Basic and Clinical Endocrinology
865:release and metabolism as well as increased
1110:Pokhrel B, Aiman W, Bhusal K (2022-10-06).
431:Decrease in thyroid hormone binding protein
2708:
2540:
2526:
2518:
2444:
556:
264:
50:
23:
2678:Familial dysalbuminemic hyperthyroxinemia
2379:
2263:
2217:
2199:
2103:
2085:
2044:
1915:
1767:
1757:
1439:
1382:
1172:
1065:, and cooling blankets and ice packs for
920:, cardiocirculatory support including VA-
439:Increased sensitivity to thyroid hormone
1943:
1941:
1939:
1937:
1935:
1308:
1306:
1304:
1260:
1258:
1256:
1254:
1252:
1250:
1248:
1212:
1210:
1208:
1206:
1099:
675:Mild (e.g. showing signs of agitation)
593:Gastrointestinal or Liver Dysfunction
219:. Mortality can be as high as 20–30%.
1791:
1789:
1787:
1662:
1660:
1658:
1656:
1654:
1652:
1650:
1648:
1646:
1543:(2 ed.). New York: McGraw-Hill.
1528:(10 ed.). New York: McGraw-Hill.
1515:
1513:
1511:
1509:
1145:Journal of Clinical Medicine Research
125:heart beat, elevated blood pressure,
7:
2724:Abadie's sign of exophthalmic goiter
1798:The Medical Clinics of North America
381:Withdrawal of antithyroid treatment
209:myocardial infarction (heart attack)
145:occurs in early to mid crisis, with
1524:. In Gardner DG, Shoback D (eds.).
1071:Extracorporeal membrane oxygenation
723:Severe (i.e. unexplained jaundice)
472:Thyroid storm as allostatic failure
2297:Therapeutic Apheresis and Dialysis
2145:10.1111/j.1365-2265.1993.tb00970.x
1710:Holt EH, Peery HE (28 July 2010).
1669:Journal of Intensive Care Medicine
1267:Journal of Intensive Care Medicine
14:
2700:Amiodarone induced thyrotoxicosis
1151:(4). Elmer Press, Inc.: 351–357.
873:when glycogen stores are depleted
554:(T4) for definite thyroid storm.
422:Increases in free thyroid hormone
2309:10.1111/j.1744-9987.2011.01003.x
1219:Medical Clinics of North America
895:due to increased bone resorption
707:Moderate (i.e. bibasilar rales)
599:Presence of Precipitating Event
581:Presence of Atrial Fibrillation
959:effect and its release via the
898:Elevated white blood cell count
94:. It occurs when an overactive
1016:beta-1-selective beta blockers
757:Severe (e.g. seizure or coma)
747:Severe (i.e. pulmonary edema)
509:non-thyroidal illness syndrome
482:non-thyroidal illness syndrome
1:
1853:10.1016/S0889-8529(18)30165-8
807:Greater than or equal to 104
779:Greater than or equal to 140
363:Radioactive iodine treatment
242:, myocardial infarction, and
153:occurring in the late stage.
102:, which can cause death from
1412:Acute Medicine & Surgery
587:Symptoms of CNS Dysfunction
558:Burch-Wartofsky Point Scale
2194:(9). Cureus, Inc.: e29321.
2029:10.1016/j.ijscr.2017.02.041
1713:Basic Medical Endocrinology
1367:10.1097/md.0000000000002848
891:Hypercalcemia and elevated
415:
2920:
2673:Thyroid hormone resistance
2352:AACE Clinical Case Reports
2080:(7). Cureus, Inc.: e9461.
1810:10.1016/j.mcna.2012.01.015
1746:Frontiers in Endocrinology
1231:10.1016/j.mcna.2012.01.015
878:aspartate aminotransferase
575:Symptoms of Heart Failure
453:Sympathetic nervous system
2864:Toxic multinodular goiter
2622:Thyroid dyshormonogenesis
2597:Van Wyk-Grumbach syndrome
2575:Congenital hypothyroidism
1581:10.1007/s00063-012-0113-2
1114:. StatPearls Publishing.
1004:enterohepatic circulation
845:As with hyperthyroidism,
458:thyroid hormone receptors
113:It is characterized by a
2023:. Elsevier BV: 112–114.
1759:10.3389/fendo.2017.00163
1681:10.1177/0885066613498053
1406:Idrose AM (2015-05-12).
1279:10.1177/0885066613498053
663:Mild (i.e. pedal edema)
213:congestive heart failure
2690:Thyrotoxicosis factitia
2592:Euthyroid sick syndrome
1522:"Endocrine Emergencies"
1088:Euthyroid sick syndrome
967:Antithyroid medications
912:is needed. In cases of
505:euthyroid sick syndrome
217:cardiovascular collapse
2766:Graves' ophthalmopathy
2364:10.4158/ACCR-2019-0132
2252:Clinical Endocrinology
2133:Clinical Endocrinology
1488:Misra M (2023-02-02).
1014:The administration of
937:mechanical ventilation
448:Sympathetic activation
406:
266:Precipitating factors
250:, toxic multi-nodular
205:abnormal heart rhythms
180:As a life-threatening
61:Differential diagnosis
2704:Hyperthyroid myopathy
2631:Hypothyroid myopathy
1963:10.1089/thy.2010.0417
1900:10.1089/thy.2011.0334
1629:10.1055/s-0042-105786
1418:(3). Wiley: 147–157.
1328:10.1089/thy.2010.0417
1000:bile acid sequestrant
886:lactate dehydrogenase
861:-mediated effects on
497:myocardial infarction
405:
336:Myocardial infarction
277:Diabetic ketoacidosis
2859:Toxic nodular goiter
2803:Subacute lymphocytic
2201:10.7759/cureus.29321
1617:Der Nuklearmediziner
985:subacute thyroiditis
935:. In severe cases,
918:hemodynamic collapse
893:alkaline phosphatase
499:and other causes of
295:Non-thyroid surgery
244:psychiatric diseases
215:, which may lead to
2720:Signs and symptoms
2601:Signs and symptoms
2087:10.7759/cureus.9461
1949:Endocrinologists".
1520:Gardner DG (2017).
1314:Endocrinologists".
1157:10.14740/jocmr3106w
1059:intensive care unit
971:Antithyroid drugs (
910:intensive care unit
841:Laboratory findings
559:
267:
2759:Pretibial myxedema
2492:External resources
1494:Medscape Reference
1063:intravenous fluids
924:may be required.
557:
407:
375:iodinated contrast
343:Pulmonary embolism
265:
188:Signs and symptoms
70:infectious disease
2886:
2885:
2774:
2773:
2668:Hyperthyroxinemia
2640:Hoffmann syndrome
2627:Pickardt syndrome
2605:Queen Anne's sign
2565:Iodine deficiency
2515:
2514:
2265:10.1111/cen.12949
1723:978-0-08-092055-9
1550:978-0-07-184313-3
933:fluid replacement
838:
837:
517:type 1 allostasis
395:
394:
391:Intense exercise
386:Emotional stress
271:Severe infection
182:medical emergency
85:
84:
35:Thyrotoxic crisis
21:Medical condition
16:Endocrine disease
2911:
2788:Acute infectious
2734:Dalrymple's sign
2709:
2542:
2535:
2528:
2519:
2445:
2433:
2432:
2400:
2394:
2393:
2383:
2343:
2337:
2336:
2292:
2286:
2285:
2267:
2243:
2232:
2231:
2221:
2203:
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2172:
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2118:
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2008:
2002:
2001:
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1945:
1930:
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1829:
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1771:
1761:
1737:
1728:
1727:
1707:
1701:
1700:
1664:
1641:
1640:
1612:
1601:
1600:
1564:
1555:
1554:
1536:
1530:
1529:
1517:
1504:
1503:
1501:
1500:
1485:
1479:
1478:
1476:
1475:
1460:
1454:
1453:
1443:
1424:10.1002/ams2.104
1403:
1397:
1396:
1386:
1346:
1340:
1339:
1310:
1299:
1298:
1262:
1243:
1242:
1214:
1201:
1200:
1193:
1187:
1186:
1176:
1136:
1130:
1129:
1127:
1126:
1107:
1067:persistent fever
973:propylthiouracil
949:potassium iodide
869:, evolving into
560:
548:triiodothyronine
489:critical illness
418:) that lead to:
290:Thyroid surgery
268:
167:propylthiouracil
55:
54:
24:
2919:
2918:
2914:
2913:
2912:
2910:
2909:
2908:
2899:Thyroid disease
2889:
2888:
2887:
2882:
2837:
2770:
2749:Griffith's sign
2739:Stellwag's sign
2713:Graves' disease
2707:
2660:Hyperthyroidism
2654:
2551:
2549:Thyroid disease
2546:
2516:
2511:
2510:
2487:
2486:
2456:
2442:
2437:
2436:
2402:
2401:
2397:
2345:
2344:
2340:
2294:
2293:
2289:
2245:
2244:
2235:
2181:
2180:
2176:
2126:
2125:
2121:
2067:
2066:
2062:
2010:
2009:
2005:
1986:Isr Med Assoc J
1983:
1982:
1978:
1947:
1946:
1933:
1881:
1880:
1876:
1838:
1837:
1833:
1795:
1794:
1785:
1739:
1738:
1731:
1724:
1709:
1708:
1704:
1666:
1665:
1644:
1614:
1613:
1604:
1566:
1565:
1558:
1551:
1538:
1537:
1533:
1519:
1518:
1507:
1498:
1496:
1487:
1486:
1482:
1473:
1471:
1462:
1461:
1457:
1405:
1404:
1400:
1348:
1347:
1343:
1312:
1311:
1302:
1264:
1263:
1246:
1216:
1215:
1204:
1195:
1194:
1190:
1138:
1137:
1133:
1124:
1122:
1112:"Thyroid Storm"
1109:
1108:
1101:
1096:
1079:
1055:
1053:Supportive care
1044:
1035:
1033:Corticosteroids
1012:
993:
969:
945:
905:
843:
735:102.0 to 102.9
695:101.0 to 101.9
651:100.0 to 100.9
540:hyperthyroidism
536:
474:
450:
441:
433:
424:
411:thyroid hormone
400:
398:Pathophysiology
315:Molar pregnancy
248:Graves' disease
228:
194:fast heart rate
190:
100:hypermetabolism
92:hyperthyroidism
49:
22:
17:
12:
11:
5:
2917:
2915:
2907:
2906:
2901:
2891:
2890:
2884:
2883:
2881:
2880:
2879:
2878:
2876:Colloid nodule
2871:Thyroid nodule
2868:
2867:
2866:
2861:
2856:
2854:Endemic goitre
2845:
2843:
2839:
2838:
2836:
2835:
2834:
2833:
2828:
2823:
2812:
2811:
2810:
2805:
2800:
2790:
2784:
2782:
2776:
2775:
2772:
2771:
2769:
2768:
2763:
2762:
2761:
2756:
2751:
2746:
2741:
2736:
2731:
2726:
2717:
2715:
2706:
2705:
2702:
2697:
2692:
2687:
2685:Hashitoxicosis
2682:
2681:
2680:
2675:
2664:
2662:
2656:
2655:
2653:
2652:
2651:
2650:
2647:
2642:
2637:
2629:
2624:
2619:
2618:
2617:
2612:
2607:
2599:
2594:
2589:
2584:
2579:
2578:
2577:
2567:
2561:
2559:
2557:Hypothyroidism
2553:
2552:
2547:
2545:
2544:
2537:
2530:
2522:
2513:
2512:
2509:
2508:
2506:article/925147
2496:
2495:
2493:
2489:
2488:
2485:
2484:
2473:
2457:
2452:
2451:
2449:
2448:Classification
2441:
2440:External links
2438:
2435:
2434:
2415:(5): 349–350.
2395:
2358:(1): e14–e18.
2338:
2303:(6): 522–531.
2287:
2233:
2174:
2119:
2060:
2003:
1992:(5): 349–350.
1976:
1957:(6): 593–646.
1931:
1894:(7): 661–679.
1874:
1847:(2): 263–277.
1831:
1804:(2): 385–403.
1783:
1729:
1722:
1702:
1675:(3): 131–140.
1642:
1623:(2): 124–131.
1602:
1556:
1549:
1531:
1505:
1480:
1468:Endocrine News
1455:
1398:
1341:
1322:(6): 593–646.
1300:
1273:(3): 131–140.
1244:
1225:(2): 385–403.
1202:
1188:
1131:
1098:
1097:
1095:
1092:
1091:
1090:
1085:
1078:
1075:
1054:
1051:
1047:Plasmapheresis
1043:
1042:Plasmapheresis
1040:
1034:
1031:
1011:
1008:
992:
989:
968:
965:
961:Plummer effect
957:Wolff–Chaikoff
953:Lugol's iodine
944:
941:
904:
901:
900:
899:
896:
889:
874:
867:glycogenolysis
857:likely due to
842:
839:
836:
835:
833:
831:
829:
827:
825:
823:
821:
819:
817:
815:
813:
811:
808:
804:
803:
801:
799:
797:
795:
793:
791:
789:
787:
785:
783:
780:
777:
774:
770:
769:
767:
765:
763:
761:
758:
755:
753:
751:
748:
745:
742:
739:
736:
732:
731:
729:
727:
724:
721:
718:
715:
713:
711:
708:
705:
702:
699:
696:
692:
691:
688:
685:
682:
679:
676:
673:
670:
667:
664:
661:
658:
655:
652:
648:
647:
644:
641:
638:
635:
632:
629:
626:
623:
620:
617:
614:
611:
608:
604:
603:
600:
597:
594:
591:
588:
585:
582:
579:
576:
573:
570:
567:
564:
535:
532:
473:
470:
466:catecholamines
462:beta receptors
449:
446:
440:
437:
432:
429:
423:
420:
399:
396:
393:
392:
388:
387:
383:
382:
378:
377:
370:
369:
365:
364:
360:
359:
353:
352:
346:
345:
339:
338:
332:
331:
327:
326:
318:
317:
311:
310:
304:
303:
297:
296:
292:
291:
287:
286:
280:
279:
273:
272:
227:
224:
189:
186:
143:pulse pressure
104:cardiac arrest
83:
82:
79:
73:
72:
63:
57:
56:
43:
37:
36:
33:
29:
28:
20:
15:
13:
10:
9:
6:
4:
3:
2:
2916:
2905:
2902:
2900:
2897:
2896:
2894:
2877:
2874:
2873:
2872:
2869:
2865:
2862:
2860:
2857:
2855:
2852:
2851:
2850:
2847:
2846:
2844:
2840:
2832:
2829:
2827:
2824:
2822:
2819:
2818:
2816:
2813:
2809:
2806:
2804:
2801:
2799:
2798:De Quervain's
2796:
2795:
2794:
2791:
2789:
2786:
2785:
2783:
2781:
2777:
2767:
2764:
2760:
2757:
2755:
2752:
2750:
2747:
2745:
2742:
2740:
2737:
2735:
2732:
2730:
2729:Boston's sign
2727:
2725:
2722:
2721:
2719:
2718:
2716:
2714:
2710:
2703:
2701:
2698:
2696:
2695:Thyroid storm
2693:
2691:
2688:
2686:
2683:
2679:
2676:
2674:
2671:
2670:
2669:
2666:
2665:
2663:
2661:
2657:
2649:Atrophic type
2648:
2646:
2643:
2641:
2638:
2636:
2633:
2632:
2630:
2628:
2625:
2623:
2620:
2616:
2613:
2611:
2608:
2606:
2603:
2602:
2600:
2598:
2595:
2593:
2590:
2588:
2587:Myxedema coma
2585:
2583:
2580:
2576:
2573:
2572:
2571:
2568:
2566:
2563:
2562:
2560:
2558:
2554:
2550:
2543:
2538:
2536:
2531:
2529:
2524:
2523:
2520:
2507:
2503:
2502:
2498:
2497:
2494:
2490:
2483:
2479:
2478:
2474:
2472:
2468:
2467:
2463:
2459:
2458:
2455:
2450:
2446:
2439:
2430:
2426:
2422:
2418:
2414:
2410:
2406:
2399:
2396:
2391:
2387:
2382:
2377:
2373:
2369:
2365:
2361:
2357:
2353:
2349:
2342:
2339:
2334:
2330:
2326:
2322:
2318:
2314:
2310:
2306:
2302:
2298:
2291:
2288:
2283:
2279:
2275:
2271:
2266:
2261:
2257:
2253:
2249:
2242:
2240:
2238:
2234:
2229:
2225:
2220:
2215:
2211:
2207:
2202:
2197:
2193:
2189:
2185:
2178:
2175:
2170:
2166:
2162:
2158:
2154:
2150:
2146:
2142:
2138:
2134:
2130:
2123:
2120:
2115:
2111:
2106:
2101:
2097:
2093:
2088:
2083:
2079:
2075:
2071:
2064:
2061:
2056:
2052:
2047:
2042:
2038:
2034:
2030:
2026:
2022:
2018:
2014:
2007:
2004:
1999:
1995:
1991:
1987:
1980:
1977:
1972:
1968:
1964:
1960:
1956:
1952:
1944:
1942:
1940:
1938:
1936:
1932:
1927:
1923:
1918:
1913:
1909:
1905:
1901:
1897:
1893:
1889:
1885:
1878:
1875:
1870:
1866:
1862:
1858:
1854:
1850:
1846:
1842:
1835:
1832:
1827:
1823:
1819:
1815:
1811:
1807:
1803:
1799:
1792:
1790:
1788:
1784:
1779:
1775:
1770:
1765:
1760:
1755:
1751:
1747:
1743:
1736:
1734:
1730:
1725:
1719:
1715:
1714:
1706:
1703:
1698:
1694:
1690:
1686:
1682:
1678:
1674:
1670:
1663:
1661:
1659:
1657:
1655:
1653:
1651:
1649:
1647:
1643:
1638:
1634:
1630:
1626:
1622:
1618:
1611:
1609:
1607:
1603:
1598:
1594:
1590:
1586:
1582:
1578:
1575:(6): 448–53.
1574:
1570:
1563:
1561:
1557:
1552:
1546:
1542:
1535:
1532:
1527:
1523:
1516:
1514:
1512:
1510:
1506:
1495:
1491:
1484:
1481:
1469:
1465:
1459:
1456:
1451:
1447:
1442:
1437:
1433:
1429:
1425:
1421:
1417:
1413:
1409:
1402:
1399:
1394:
1390:
1385:
1380:
1376:
1372:
1368:
1364:
1360:
1356:
1352:
1345:
1342:
1337:
1333:
1329:
1325:
1321:
1317:
1309:
1307:
1305:
1301:
1296:
1292:
1288:
1284:
1280:
1276:
1272:
1268:
1261:
1259:
1257:
1255:
1253:
1251:
1249:
1245:
1240:
1236:
1232:
1228:
1224:
1220:
1213:
1211:
1209:
1207:
1203:
1198:
1192:
1189:
1184:
1180:
1175:
1170:
1166:
1162:
1158:
1154:
1150:
1146:
1142:
1135:
1132:
1121:
1117:
1113:
1106:
1104:
1100:
1093:
1089:
1086:
1084:
1083:Myxedema coma
1081:
1080:
1076:
1074:
1072:
1068:
1064:
1060:
1052:
1050:
1048:
1041:
1039:
1032:
1030:
1027:
1023:
1021:
1017:
1010:Beta blockers
1009:
1007:
1005:
1001:
997:
996:Colestyramine
991:Colestyramine
990:
988:
986:
982:
978:
974:
966:
964:
962:
958:
954:
950:
942:
940:
938:
934:
930:
925:
923:
919:
915:
914:heart failure
911:
902:
897:
894:
890:
887:
883:
879:
875:
872:
868:
864:
860:
859:catecholamine
856:
855:Hyperglycemia
853:
852:
851:
848:
840:
834:
832:
830:
828:
826:
824:
822:
820:
818:
816:
814:
812:
809:
806:
805:
802:
800:
798:
796:
794:
792:
790:
788:
786:
784:
781:
778:
775:
773:103 to 103.9
772:
771:
768:
766:
764:
762:
759:
756:
754:
752:
749:
746:
743:
740:
737:
734:
733:
730:
728:
725:
722:
719:
716:
714:
712:
709:
706:
703:
700:
697:
694:
693:
689:
686:
683:
680:
677:
674:
671:
668:
665:
662:
659:
656:
653:
650:
649:
645:
642:
639:
636:
633:
630:
627:
624:
621:
618:
615:
612:
609:
607:99.0 to 99.9
606:
605:
601:
598:
595:
592:
589:
586:
583:
580:
577:
574:
571:
568:
565:
562:
561:
555:
553:
550:(T3) or free
549:
545:
541:
533:
531:
528:
526:
522:
518:
514:
510:
506:
502:
498:
494:
490:
485:
483:
479:
471:
469:
467:
463:
459:
454:
447:
445:
438:
436:
430:
428:
421:
419:
417:
416:§ Causes
412:
404:
397:
390:
389:
385:
384:
380:
379:
376:
372:
371:
367:
366:
362:
361:
358:
357:Heart failure
355:
354:
351:
348:
347:
344:
341:
340:
337:
334:
333:
329:
328:
324:
321:Trauma (i.e.
320:
319:
316:
313:
312:
309:
308:Struma ovarii
306:
305:
302:
299:
298:
294:
293:
289:
288:
285:
282:
281:
278:
275:
274:
270:
269:
263:
261:
257:
256:toxic adenoma
253:
249:
245:
241:
237:
233:
225:
223:
220:
218:
214:
210:
206:
202:
197:
195:
187:
185:
183:
178:
176:
175:Beta blockers
172:
168:
163:
160:
156:
155:Heart failure
152:
149:accompanying
148:
144:
140:
136:
132:
128:
124:
120:
116:
111:
109:
108:organ failure
105:
101:
97:
93:
89:
88:Thyroid storm
80:
78:
74:
71:
67:
64:
62:
58:
53:
47:
46:Endocrinology
44:
42:
38:
34:
30:
27:Thyroid storm
25:
19:
2694:
2610:Woltman sign
2499:
2475:
2460:
2412:
2408:
2398:
2355:
2351:
2341:
2300:
2296:
2290:
2258:(6): 912–8.
2255:
2251:
2191:
2187:
2177:
2139:(1): 39–43.
2136:
2132:
2122:
2077:
2073:
2063:
2020:
2016:
2006:
1989:
1985:
1979:
1954:
1950:
1891:
1887:
1877:
1844:
1840:
1834:
1801:
1797:
1749:
1745:
1712:
1705:
1672:
1668:
1620:
1616:
1572:
1568:
1540:
1534:
1525:
1497:. Retrieved
1493:
1483:
1472:. Retrieved
1470:. 2014-08-01
1467:
1458:
1415:
1411:
1401:
1358:
1354:
1344:
1319:
1315:
1270:
1266:
1222:
1218:
1191:
1148:
1144:
1134:
1123:. Retrieved
1056:
1045:
1036:
1024:
1013:
994:
970:
946:
926:
906:
871:hypoglycemia
844:
563:Temperature
544:JTA criteria
537:
529:
512:
508:
504:
487:Usually, in
486:
475:
451:
442:
434:
425:
408:
373:Exposure to
323:hip fracture
284:Hypoglycemia
229:
221:
198:
191:
179:
164:
159:heart attack
141:with a wide
139:Hypertension
112:
106:or multiple
87:
86:
18:
2842:Enlargement
2821:Hashimoto's
2780:Thyroiditis
2754:Möbius sign
1026:Propranolol
998:is an oral
977:methimazole
929:paracetamol
916:leading to
741:130 to 139
701:120 to 129
657:110 to 119
569:Heart Rate
521:glutathione
301:Parturition
254:, solitary
240:dehydration
171:methimazole
147:hypotension
32:Other names
2893:Categories
2826:Postpartum
2815:Autoimmune
1499:2023-05-28
1474:2023-05-28
1125:2023-05-28
1094:References
1020:metoprolol
903:Management
613:90 to 109
511:(NTIS) or
478:allostatic
260:amiodarone
121:and often
115:high fever
2817:/chronic
2808:Palpation
2570:Cretinism
2501:eMedicine
2421:1565-1088
2372:2376-0605
2317:1744-9987
2210:2168-8184
2153:0300-0664
2096:2168-8184
2037:2210-2612
1908:1557-9077
1861:0889-8529
1818:1557-9859
1432:2052-8817
1375:0025-7974
1165:1918-3003
983:involves
882:bilirubin
876:Elevated
552:thyroxine
534:Diagnosis
525:mortality
135:agitation
123:irregular
98:leads to
77:Prognosis
41:Specialty
2831:Riedel's
2793:Subacute
2615:Myoedema
2582:Myxedema
2429:37245101
2390:32984516
2333:22810551
2325:22107688
2274:26387649
2228:36277558
2169:41498511
2114:32760639
2055:28399492
1998:37245101
1971:21510801
1926:22690898
1826:22443982
1778:28775711
1697:21369274
1689:23920160
1637:77685062
1597:31285541
1589:22878518
1450:29123713
1393:26886648
1355:Medicine
1336:21510801
1295:21369274
1287:23920160
1239:22443982
1183:29511425
1120:28846289
1077:See also
981:etiology
687:Present
669:Present
201:jaundice
131:diarrhea
127:vomiting
2904:Thyroid
2744:lid lag
2482:D013958
2381:7279771
2282:3050566
2219:9580232
2161:8435884
2105:7392358
2046:5387892
1951:Thyroid
1917:3387770
1888:Thyroid
1869:8325286
1769:5517413
1752:: 163.
1441:5667251
1384:4998648
1316:Thyroid
1174:5827921
880:(AST),
863:insulin
625:Absent
507:(ESS),
96:thyroid
2849:Goitre
2427:
2419:
2388:
2378:
2370:
2331:
2323:
2315:
2280:
2272:
2226:
2216:
2208:
2188:Cureus
2167:
2159:
2151:
2112:
2102:
2094:
2074:Cureus
2053:
2043:
2035:
1996:
1969:
1924:
1914:
1906:
1867:
1859:
1824:
1816:
1776:
1766:
1720:
1695:
1687:
1635:
1595:
1587:
1547:
1448:
1438:
1430:
1391:
1381:
1373:
1334:
1293:
1285:
1237:
1181:
1171:
1163:
1118:
1018:(e.g.
943:Iodine
602:Score
596:Score
590:Score
584:Score
578:Score
572:Score
566:Score
493:sepsis
491:(e.g.
460:(esp.
350:Stroke
330:Burns
252:goiter
236:sepsis
226:Causes
211:, and
133:, and
66:Sepsis
48:
2471:E05.5
2329:S2CID
2278:S2CID
2165:S2CID
1693:S2CID
1633:S2CID
1593:S2CID
1291:S2CID
888:(LDH)
643:None
637:None
631:None
619:None
501:shock
258:, or
232:fever
151:shock
2645:LEMS
2635:KDSS
2477:MeSH
2425:PMID
2417:ISSN
2386:PMID
2368:ISSN
2321:PMID
2313:ISSN
2270:PMID
2224:PMID
2206:ISSN
2157:PMID
2149:ISSN
2110:PMID
2092:ISSN
2051:PMID
2033:ISSN
1994:PMID
1967:PMID
1922:PMID
1904:ISSN
1865:PMID
1857:ISSN
1822:PMID
1814:ISSN
1774:PMID
1718:ISBN
1685:PMID
1585:PMID
1545:ISBN
1446:PMID
1428:ISSN
1389:PMID
1371:ISSN
1332:PMID
1283:PMID
1235:PMID
1179:PMID
1161:ISSN
1116:PMID
922:ECMO
884:and
157:and
119:fast
2462:ICD
2376:PMC
2360:doi
2305:doi
2260:doi
2214:PMC
2196:doi
2141:doi
2100:PMC
2082:doi
2041:PMC
2025:doi
1959:doi
1912:PMC
1896:doi
1849:doi
1806:doi
1764:PMC
1754:doi
1677:doi
1625:doi
1577:doi
1573:107
1436:PMC
1420:doi
1379:PMC
1363:doi
1324:doi
1275:doi
1227:doi
1169:PMC
1153:doi
975:or
951:or
847:TSH
810:30
782:25
776:25
760:30
750:15
744:20
738:20
726:20
720:20
710:10
704:15
698:15
690:10
684:10
678:10
672:10
660:10
654:10
169:or
2895::
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2466:10
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