**3.1 Pathophysiology of thyroid storm**

Thyroid storm pathophysiology is summarized in **Figure 1**.

Several theories are proposed for thyroid storm. A precipitating factor is always required to initiate thyroid storm, the most accepted hypothesis is that rapid, sudden increase in thyroid hormone levels, thus free hormones released from the proteinbound hormones, causing sudden increase in body metabolism, thus causing an exaggerated signs and manifestations of hyperthyroidism with multiple organs dysfunction (**Table 1**).

The histopathologic findings depend upon the etiology of thyroid storm, if it is due to Graves' disease goiter, the histopathology will show diffuse follicular hyperplasia along with increased receptor antibodies with increased vascularity. If thyroid storm is due to malignancy, the histopathology will reveal ruptured follicles with malignant cells inhibition with disturbs of thyroid cells [5].


#### **Table 1.**

*Precipitating factors for the thyroid storm.*

**Figure 1.** *Pathophysiology of thyroid storm.*
