Thyroid Storm in the Intensive Care Unit

Abstract

Thyroid storm (TS) is a rare but life-threatening endocrine emergency. Diagnosis may be challenging as the clinical features are variable and lack specificity. TS occurs in patients with unknown thyroid disease in up to 40%. Early recognition is required to start prompt and specific management. TS presentation may be fulminant, involving frequent cardiac manifestations associated with a more dismal prognosis. As multiorgan dysfunction can occur, early ICU admission is necessary, and the therapeutic modalities should be closely discussed with endocrinologists. Therapeutic management should be aggressive, and multimodal, including treatment(s) directed against thyroid-hormone secretion and synthesis, and blockade of the peripheral thyroid-hormone actions.Importantly, b-blockers should be used very cautiously or avoided in the most severe TS forms as a cardiogenic shock is frequent. Their administration should be preceded and followed by a thorough echocardiographic assessment. Plasmapheresis and thyroidectomy during ICU stay might be considered in some patients as alternative therapeutic modalities but it remains difficult to know who may likely benefit and what is the optimal timing due to scarce literature.