Perioperative Thyroid Storm: A Medical and Surgical Emergency

*Mohammad Zubair, Wael Khalaf, Zia Awan, Hossam Algallie, Nissar Shaikh and Gamal Al-Ameri*

### **Abstract**

Thyroid storm is rare, acute medical endocrine emergency. It is aggressive manifestation of the hyperthyroid state. If delayed or not treated can be fatal or cause severe disabilities. Historically thyroid storm was a common complication of toxic goiter and goiter surgery but recently more common in hyperthyroidism patients with acute illness or surgical intervention and inadequately treated hyperthyroid patients. There is usually precipitating factor that lead to thyroid storm, such as emergency surgery, extreme stress, or acute severe illness. Clinical manifestations involve major body organ dysfunctions and range from fever, dysrhythmias, heart failure, vomiting, diarrhea, jaundice, and convulsions to coma. The pathophysiology of thyroid storm is organ dysfunction due to excessive thyroid hormones. Thyroid storm is diagnosed by clinical presentation, Electrocardiogram (ECG), chest X-ray findings and thyroid point of care ultrasound (POCUS), and the scoring systems. Management should be started without delay. Apart from supportive care airway, breathing, circulation, and disability (ABCD) approach and antithyroid medications should be administered. Delay in management will increase morbidity and mortality. Initially, propylthiouracil (PTU), beta-blocker, iodine, steroids, and bile chelating agent are the treatment. The thyroid mortality ranges from 20 to 30%.

**Keywords:** thyroid storm, fatal, precipitating factors, thyroxine T3 and T4 toxicosis, arrhythmias, fever, multiorgan dysfunctions, beta-blockers, iodine, steroid, bile chelating agents

## **1. Introduction**

Thyroid storm is an acute and rare life-threatening clinical condition, complicated manifestation of severe hyperthyroidism, with multiple organ involvement. It was described in 1926 that thyroid storm had high morbidity and mortality, despite advancement in medical sciences. Hence it is essential to recognize this life-threatening syndrome early and manage it earlier to improve patient's outcome. It is equally important that acute care physicians, surgeons and general practitioners, intensivists, and paramedical staffs are accustomed to the presentation and management of this rare endocrine disease [1].
