Thyroid storm (thyrotoxic crisis) is a form of severe hyperthyroidism, usually of abrupt onset and manifested by cardiac dysrhythmias, fever, and neurologic impairment that frequently appears as delirium. Thyroid storm is a life-threatening condition that is usually precipitated by one or more of the following: stress (such as with an injury), infection, surgery, tooth extraction, insulin reaction, diabetic ketoacidosis, pregnancy, digitalis intoxication, abrupt withdrawal of antithyroid drugs, extreme emotional stress, or vigorous palpation of the thyroid. These factors precipitate thyroid storm in the partially controlled or completely untreated patient with hyperthyroidism. Untreated thyroid storm is almost always fatal but, with proper treatment, the mortality rate can be reduced substantially.

• High fever (hyperpyrexia) above 38.5°C (101.3°F)
• Extreme tachycardia (more than 130 bpm)
• Exaggerated symptoms of hyperthyroidism with disturbances of a major system, such as gastrointestinal (weight loss, diarrhea, abdominal pain) or cardiovascular (edema, chest pain, dyspnea, palpitations)
• Altered neurologic or mental state, which frequently appears as delirium psychosis, somnolence, or coma

Immediate objectives are to reduce body temperature and heart rate and prevent vascular collapse.

• A hypothermia mattress or blanket, ice packs, a cool environment, and acetaminophen (Tylenol) are used.
• Humidified oxygen is given to improve tissue oxygenation and meet high metabolic demands, and respiratory status is monitored by arterial blood gas analysis or pulse oximetry.
• Intravenous fluids containing dextrose are given to replace glycogen stores.
• Hydrocortisone is given to treat shock or adrenal insufficiency.
• Propylthiouracil (PTU) or methimazole is given to impede formation of thyroid hormone.
• Iodine is given to decrease output of thyroxine (T₄) from thyroid gland.
• Sympatholytic agents are given for cardiac problems. Propranolol, combined with digitalis, has been effective in reducing cardiac symptoms.

Quality and Safety Nursing Alert

Observe patient carefully and provide aggressive and supportive nursing care during and after the acute stage of illness. Care provided for the patient with hyperthyroidism is the basis for nursing management of patients with thyroid storm.

For more information, see Chapter 52 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.