storm
(storm 
)
A sudden outburst or exacerbation of the symptoms of a disease.
cytokine s.The massive release of interleukins, tumor necrosis factor alpha, and other circulating mediators of inflammation during critical illness. These agents may trigger bleeding, clotting, internal organ injury, or shock.
electrical s.Recurring episodes of unstable ventricular tachycardia or ventricular fibrillation within 24 hr of a first life-threatening arrhythmia.
It is treated with amiodarone and a beta blocking drug.
thyroid s.A rare but often life-threatening medical emergency resulting from untreated hyperthyroidism. It is marked by fevers, sweating, restlessness, irritability, tachycardia, hypertension, heart failure, shock, cardiac arrhythmias, delirium, and coma. It may begin when a patient with hyperthyroidism suffers a second illness (such as an infection), after thyroid gland surgery, or after withdrawal from antithyroid drug treatment. SYN: thyroid crisis; thyrotoxic crisis.
It is estimated to occur in two people per million. Approx. 10% of people hospitalized with thyroid disorders experience thyroid storm.
Physiological decompensation in patients with hyperthyroidism can occur as a result of a variety of illnesses or stresses. Patients who are treated for hyperthyroidism but who choose to stop antithyroid drugs may experience thyroid storm, as may hyperthyroid patients who develop serious infections, or patients who are injured, burned, or otherwise traumatized. Thyroid storm also commonly occurs in hyperthyroid patients during surgery and labor and delivery and after life-threatening illnesses such as myocardial infarction or pulmonary embolism. Finally, exposure to some medications that impact thyroid hormone function (such as amiodarone) or radiological contrast can precipitate the syndrome.
Multiple organ systems are affected by thyroid storm. Patients typically are systemically ill, with fevers, tachycardia or atrial fibrillation, heart failure, hepatic injury (and jaundice), and diarrhea.
The clinical diagnosis is supported by the finding of a suppressed TSH (thyroid stimulating hormone) level, and elevated levels of free triiodothyronine (T3) and levothyroxine (T4) in the blood. Additional diagnostic studies on patients suspected of thyroid storm should include chest x-rays, blood cultures, and urinalyses (to identify infection), stool cultures, liver function tests, and electrocardiography.
Antithyroid medications (such as propylthiouracil) are used to block further synthesis by the thyroid gland of new thyroid hormone. Iodine is given (either as potassium iodide or Lugol solution) to prevent the thyroid gland from releasing any previously synthesized hormone. Beta blockers (such as propranolol) are used to manage tachycardia and other effects of thyroid hormone on cells throughout the body. Additional agents that may prove useful include high-dose corticosteroids to inhibit conversion of T4 to T3 and to replace depleted cortisol, volume infusions to treat dehydration, and cholestyramine, to prevent reabsorption of excreted thyroid hormones from the gastrointestinal tract. Any secondary illness should be aggressively treated, e.g., antibiotics for infections.
Mortality in thyroid storm ranges from 10% to 30%. Most patients are managed during the acute illness in ICUs.
Supplemental oxygen is administered, along with nutrients and vitamins to manage the hypermetabolic state. A calm, cool, darkened, and quiet atmosphere helps to reduce restlessness. Underlying infections are treated with antibiotics. Acetaminophen is given to reduce fevers; aspirin and other salicylates should be avoided because they may displace bound thyroid hormone from plasma proteins and worsen thyroid storm. Anxiolytic drugs are used to reduce psychological distress. Cardiac status, level of consciousness, fluid and electrolyte balance, and blood glucose are monitored closely. After the crisis resolves, adherence to prescribed medications and close outpatient follow-up may be needed with health care providers. Medical management of hyperthyroidism on an outpatient basis involves adjustment of drug doses, regular follow-up of thyroid function tests, complete blood counts, and prompt evaluation of fevers, sore throat, tachycardias, or other complications. Surgical referral may be needed for the patient requiring thyroidectomy. Consultation with an endocrinologist is advisable during the management of thyroid storm.
ventricular tachycardia s. SYN: electrical storm.