Treatment targeted against thyroid hormone creation and release. 12(2):e13539. Head & Neck. Based on a work at https://medcraveonline.com Contact Us, 2014-2023 MedCrave Group. If you have a total thyroidectomy, or the entire thyroid gland is removed, you will require prescription thyroid replacement therapy after their procedure. 1999 Dec;29(4):318-21 12(2):e13539. With the proper medical treatment, youll likely feel better within 24 hours. CT chest/abdomen/pelvis showed an 11cm right thyroid mass extending into the mediastinum with extensive disease and MRI brain showed metastases. Perioperative risk as it relates to the degree of thyroid dysfunction is also discussed separately. This article explores common side effects of thyroid surgery, what to expect during the recovery process, and warning signs of complications. The hardening typically peaks about three weeks after surgery and then subsides over the next two to three months. While there is no specific treatment for this hoarseness, it's helpful for your loved ones to be aware of the problem so that you don't feel the need to talk loudly or more often than is comfortable. There has been some controversy over inpatient vs. outpatient thyroidectomies, especially with the recent trend toward same-day surgery. Thyrotoxicosis: Signs, Symptoms, Diagnosis & Treatment - Cleveland Clinic [11]. 63(12):1025-64. [5, 8], Cardiogenic shock (CS) is a rare complication of thyroid storm, which occurs more commonly in male patients with preexisting structural and atherosclerotic heart disease, and carries a very poor prognosis. These include: While a total thyroidectomy is more extensive surgery than a subtotal thyroidectomy, several studies suggest that the safety of the two procedures is similar with regard to complications, though temporary low calcium levels (and hypothyroidism due to the removal of the entire thyroid) are more common with the total procedure. [QxMD MEDLINE Link]. 2016 Aug 27. [Full Text]. While complications can affect anyone, there are some risk factors that increase the chance of the adverse effects. Post Operative Expectations. A 2018 study found that when a solution of potassium iodide was given prior to thyroid surgery for those with Grave's diseasea condition that can lead to an overactive thyroidit was associated with less temporary hypoparathyroidism and hoarseness. [6] The incidence of thyroid storm is approximately 0.65 cases per 100,000 persons per year and 5.2 per 100,000 hospitalized patients per year. What happens after a thyroidectomy depends on how much of the thyroid gland is removed. Policy. Thyroid Hormone Reference Range May Not Apply for Cancer Patients, FDA OKs Pembrolizumab for Adjuvant Treatment of NSCLC, Recognizing the Signs: Heart Failure and Type 2 Diabetes, Myopathies: Muscling Your Way to the Diagnosis. But if severe symptoms occur, intravenous calcium, which is delivered through a vein, in the hospital may be required. 2019 Jan. 29(1):36-43. Clinical features and hospital outcomes in thyroid storm: a retrospective cohort study. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. Your surgeon will talk to you about whether you should continue to wear a dressing over your incision. Always taking your medication as prescribed by your healthcare provider. 2013 Nov;122(11):679-82. doi: 10.1177/000348941312201103. [QxMD MEDLINE Link]. Initially, glucocorticoids were used to treat potential relative insufficiency due to accelerated production and degradation owing to the hypermetabolic state. Propranolol is the drug of choice to counter peripheral action of thyroid hormone. It produces dramatic improvement in clinical status and greatly ameliorates symptoms. In addition, hormone levels may rise rapidly when the gland is manipulated during surgery, during vigorous palpation during examination, or from damaged follicles following RAI therapy. Nafisa K Kuwajerwala, MD Staff Surgeon, Breast Care Center, William Beaumont Hospital [9] : Central nervous system (CNS) dysfunction at admission, Lack of antithyroid drug and beta-blockade use, Need for mechanical ventilation and plasma exchange along with hemodialysis, In addition, CNS dysfunction of greater than mild severity appears to be a risk factor for mortality. 2018;40(1):192-202. doi:10.1002/hed.24934. Approximately 10% to 30% of thyroid storm cases result in death. The intravenous preparation of sodium iodide (given as 1 g slow infusion q8-12h) has been taken off of the market. [QxMD MEDLINE Link]. Like you dont have control of your body. Ophthalmopathy, which is a complication of Graves disease that involves eye issues such as swelling and bulging eyes. Thyroid storm is a clinical manifestation of an extreme hyperthyroid state that results in significant morbidity or disability or even death. The decision to include a boxed warning was based on the FDA's review of postmarketing safety reports and meetings held with the American Thyroid Association, the National Institute of Child Health and Human Development, and the pediatric endocrine clinical community. [17], American Thyroid Association guidelines recommend that patients undergoing thyroidectomy be rendered euthyroid with methimazole preoperatively and that potassium iodide (KI) be given in the immediate preoperative period. Rotate both shoulders forward in a circular motion. Bone and lung metastases are the most common sites for functional lesions. Post Operative Expectations | American Thyroid Association The FDA has identified 32 cases (22 adult and 10 pediatric) of serious liver injury associated with propylthiouracil (PTU). American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Kulaksizoglu M, Gonen MS, Kebapcilar L, et al. Treatment usually includes IV antibiotics, which are medications to kill bacteria that are delivered through a vein. Multivitamins, especially vitamin B-1, are added to prevent Wernicke encephalopathy. Factors associated with mortality of thyroid storm: analysis using a national inpatient database in Japan. [Full Text]. Pokhrel B, Aiman W, Bhusal K. Thyroid Storm. Br J Anaesth. HHS Vulnerability Disclosure, Help Safety and effectiveness of total thyroidectomy and its comparison with subtotal thyroidectomy and other thyroid surgeries: a systematic review. Kandil E, Khalek MA, Thethi T, Abd Elmageed Z, Khan A, Jaffe BM. You should also avoid any heavy lifting or strenuous activities, such as many sports, for a few weeks. Successful treatment of thyroid storm with plasmapheresis in a patient with methimazole-induced agranulocytosis. Martin D. Disseminated intravascular . Lugol solution or saturated solution of potassium iodide can be used. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvODUwOTI0LXRyZWF0bWVudA==. De Leo S, Lee SY, Braverman LE. They secrete parathyroid hormone that helps your kidneys and bones to maintain the balance of calcium and phosphorous. Thabet Abbarah, MD, FACS is a member of the following medical societies: American College of SurgeonsDisclosure: Nothing to disclose. In addition to persistent hoarseness, injury to the recurrent laryngeal nerve may lead to other symptoms after surgery. [QxMD MEDLINE Link]. Adrenergic receptor activation is another hypothesis. Last reviewed by a Cleveland Clinic medical professional on 06/08/2022. Dean Toriumi, MD Associate Professor, Department of Otolaryngology, University of Illinois Medical CenterDisclosure: Nothing to disclose. J Clin Endocrinol Metab. [Full Text]. What Is the Recovery Time for Appendicitis Surgery? Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. 2012 Apr. Pokhrel B, Aiman W, Bhusal K. Thyroid Storm. Thyrotoxic Storm Following Thyroidectomy Guidelines - Medscape Noncardioselective beta-blockers (eg, propranolol, esmolol) cannot be used in patients with congestive cardiac failure, bronchospasm, or history of asthma. Common symptoms include having a high fever and a rapid heart rate. Presently, the most common cause of thyroid storm is intercurrent illness or infection. She had been followed by her family doctor since 2006, but she had stopped taking her medication of her own volition in 2010. Its a rare complication of hyperthyroidism. [Full Text]. Like your heart is going to beat out of your chest. It is uncommon, but when it occurs after thyroidectomy, it is usually associated with Grave's disease. Not all cases of thyroid storm are preventable, but if you have hyperthyroidism, there are things you can do to try to prevent thyroid storm, including: Thyroid storm can be caused by your bodys stress response to surgery or anesthesia. Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y. Gently turn your head to the right, then roll your head so that you are looking at the floor, then gently roll your head to the left. Regular thyroid function tests may need to be done, especially if you start to get symptoms of hypothyroidism. The .gov means its official. Plasmapheresis, plasma exchange, peritoneal dialysis exchange transfusion, and charcoal plasma perfusion are other techniques used to remove excess circulating hormone. This excessive hypermetabolic state, with increased intestinal transit and tachypnea, leads to immense fluid loss. 2012 Sep. 109(3):466-7. Antithyroid drugs are administered for 12-24 months, during which, a remission may occur. A history of hepatotoxicity or agranulocytosis from previous thioamide therapy precludes use of PTU and MMI. In turn, increased THs increase the density of beta-adrenergic receptors, thereby enhancing the effect of catecholamines. This can include changes in blood pressure or heart problems. The recommendation to render patients euthyroid with antithyroid medication is an effort to reduce the risk of thyroid storm that the stress of surgery could precipitate. Thyroidectomy Guide: Causes, Symptoms and Treatment Options - Drugs.com [Guideline] Satoh T, Isozaki O, Suzuki A, et al. The risk of infection is present with any type of surgery but is relatively rare with thyroid surgery. 4 Thyroid storm is . Surgical management of an atypical presentation of a thyroid storm. Diarrhea, increased appetite with loss of weight, 3. [Full Text]. Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm after thyroidectomy? think "functional metastatic thyroid Thyroid storm is a serious and life-threatening medical condition. Cardiac decompensation, although seen more frequently in elderly patients, may appear in younger patients and in patients without underlying cardiac disease. Lid lag, which is when your upper eyelid is higher than it should be when youre looking down. Galindo RJ, Hurtado CR, Pasquel FJ, Garcia Tome R, Peng L, Umpierrez GE. Confusion, agitation, delirium, frank psychosis, seizures, stupor, or coma. Surgical Management of Graves' Disease - American Thyroid Association Bethesda, MD 20894, Web Policies Most often, lifelong calcium supplementation is all that is needed. Possible complications of general anesthesia may also occur since most thyroidectomies require it. StatPearls [Internet]. Thyroidectomy then and now: a 50-year Australian perspective. Thyroidectomy for Selected Patients With Thyrotoxicosis Metabolism is the pace at which your body processes things how fast it burns food to make energy and heat. [QxMD MEDLINE Link]. National trends in incidence, mortality, and clinical outcomes of patients hospitalized for thyrotoxicosis with and without thyroid storm in the United States, 2004-2013. Xray and CT femur showed a pathological fracture of the right distal femur. The authors declare no conflicts of interest. sharing sensitive information, make sure youre on a federal KI is recommended to reduce thyroid gland vascularity with the goal of improving operative visualization and reducing operative complications. Mimi S Kokoska, MD Physician, Department of Otolaryngology-Head and Neck Surgery, Aurora Health Care If your throat is sore or if swallowing is painful, eating a diet of soft foods will be more comfortable. 46(2):149-52. Thyroid storm is the most severe form of hyperthyroidism, wherein organ failure begins to occur. official website and that any information you provide is encrypted Nagata T, Shimada Y, Miwa T, Hashimoto I, Kojima H, Okumura T, Tsukada K. Surg Today. Nausea, vomiting, severe diarrhea, abdominal pain, hepatocellular dysfunction-jaundice, 4. Antithyroid medication (thionamides) to stop your thyroid from making new thyroid hormones. Though thyroid surgery is considered a relatively safe procedure, complications may sometimes occur. In addition, dexamethasone and hydrocortisone have an inhibitory effect on conversion of T4 to T3. Effective Preoperative Plasmapheresis Treatment of Severe Hyperthyroidism in a Patient with Giant Toxic Nodular Goiter and Methimazole-Induced Agranulocytosis. A drop in binding protein levels, which may occur postoperatively, might cause a sudden rise in free hormone levels. Your thyroid gland produces and releases two hormones called triiodothyronine (also called T3) and thyroxine (also called T4). Emergent thyroidectomy has been shown to be safe for treating TS without obtaining euthyroid status prior to the procedure. You are being redirected to
With this in mind, it's a good idea to ask your surgeon how many thyroidectomies they have performed in the past. Terris DJ, Snyder S, Carneiro-pla D, et al. This option may be indicated if a thyroid nodule is small and localized to one side of the . 2012 Apr. No part of this content may be reproduced or transmitted in any form or by any means as per the standard guidelines of fair use Impact of potassium iodide on thyroidectomy for Graves disease: Implications for safety and operative difficulty. Pathophysiologic mechanisms of Graves disease relating thyroid-stimulating immunoglobulins to hyperthyroidism and ophthalmopathy. She is the author of "The Thyroid Diet Revolution.". [Full Text]. Many surgeons recommend doing gentle stretching and range-of-motion exercises to reduce stiffness. Propranolol blocks beta-adrenergic receptors and prevents conversion of T4 to T3. Dont wait for your symptoms to get worse. While the fluid is often reabsorbed by the body, large seromas may need to be drained. Lancet. In the meantime, be sure to contact your thyroid-care team if you have any questions regarding your recovery process. MeSH Thyroid storm is a rare and life-threatening condition that can affect people with hyperthyroidism. ATD and blockers should be titrated according to thyroid function. Medicine (Baltimore). (See "Nonthyroid surgery in the patient with thyroid disease" and "Surgical management of hyperthyroidism" and "Thyroidectomy" and "Thyroid storm".) These symptoms typically last for only a short time. If the nerve was injured, more severe symptoms may be noted after surgery. If you log out, you will be required to enter your username and password the next time you visit. This website also contains material copyrighted by 3rd parties. Complications are rare but can be serious and even potentially life-threatening if they do occur. These reports suggest an increased risk for liver toxicity with PTU compared with methimazole. Werner and Ingbar'sThe Thyroid: A Fundamental and Clinical Text. We do not endorse non-Cleveland Clinic products or services. Hambleton C, Buell J, Saggi B, Balart L, Shores NJ, Kandil E. Ann Otol Rhinol Laryngol. Nafisa K Kuwajerwala, MD is a member of the following medical societies: American College of Surgeons, American Society of Breast Surgeons, American Society of Breast DiseaseDisclosure: Nothing to disclose. government site. WHO SHOULD CONSIDER THYROIDECTOMY FOR MANAGEMENT OF GRAVES' DISEASE? The boxed warning emphasizes the risk for severe liver injury and acute liver failure, which have been fatal in some cases. While around 1% of people may have damage to the nerves supplying the vocal cords, around 5% to 10% of people will have temporary symptoms due to irritation of the nerves during surgery or inflammation around the nerves afterward. Most people are advised to take roughly two weeks off from work to recuperate, depending on their occupation. [QxMD MEDLINE Link]. 2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition). Treatment in the intensive care unit includes cooling, intravenous fluids, medications such as propylthiouracil (PTU), and management of arrhythmias. Venkata Subramanian Kanthimathinathan, MD Fellow in Bariatric/Advanced Laparoscopic Surgery, University of Missouri HealthcareDisclosure: Nothing to disclose. Some surgeons may reintroduce iodine for 10 days prior to surgery if subtotal thyroidectomy is planned. Your incision may appear red and hard at first,and you may notice some slight swelling and bruising around the scar. Keep in mind, as well, that the likelihood of a complication occurring is much less with an experienced surgeon. Thyroid. Thyroid Eye Disease After Thyroidectomy - ThyroidProAdvice.com ", Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Fortunately, if nausea does develop, there are treatments that can alleviate your symptoms, and the use of medications such as dexamethasone has greatly reduced vomiting. Use of a cooled humidified oxygen tent is advised. You may be given calcium and vitamin D supplements, and hormone replacement therapy is needed in some cases. Endocr Pract. Thyroidectomy - Harvard Health 2011 Dec. 15(6):522-31. Complications are much less common and can include neck bleeding, permanent hypoparathyroidism that requires ongoing calcium replacement, and damage to nerves that can lead to long-term hoarseness and vocal changes. Thyroidectomy is the main surgical treatment for thyroid cancer and is a treatment option for certain thyroid conditions, including: Thyroid nodules: A thyroid nodule is a growth (lump) of thyroid cells in your thyroid gland. Thyroid Surgery (Thyroidectomy): Prep and Recovery - Verywell Health Patients unable to take PTU or MMI also can be treated with lithium, as use of iodine alone is debatable. [Full Text]. [QxMD MEDLINE Link]. Seidlin SM, Marinelli LD, Oshry E. Radioactive iodine therapy. 216.444.6568 Appointments & Locations Request an Appointment Virtual Visits for Diabetes Your thyroid is a butterfly-shaped gland located in the front of your neck. They may be due to irritation from the breathing tube inserted into the windpipe during surgery, or the result of nerve irritation caused by the procedure. Luckily, its rare and treatable. Medscape Education. Hamdi M, Chaudhri A, Shah N, et al. Most of these will be temporary, but some may persist. Dare to Compare: Do You Know the Latest on Immuno-Oncology in Advanced Non-Small Cell Lung Cancer? De Leo S, Lee SY, Braverman LE. Bleeding into the tissues surrounding the neck, which is known as a neck hematoma, is uncommon, but is potentially life-threatening if not diagnosed and treated promptly. Complications after thyroid surgery are rare but can be serious and potentially life threatening. If you are having thyroid surgery, known as a thyroidectomy, to remove all or part of your thyroid glanda butterfly shaped organ at the base of your neckit's important to know what to expect as you recover. Ther Apher Dial. A seroma is a collection of fluid that can occur after many types of surgery. [Full Text]. Only a few studies have tried to report the risks of hypoparathyroidism. 2009 Feb. 102(2):193-5. Peter F Czako, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, Michigan State Medical Society, American Association of Endocrine Surgeons, Detroit Surgical SocietyDisclosure: Nothing to disclose. TRAB was >40 IU/mL (normal <0.7 IU/mL). [Full Text]. [QxMD MEDLINE Link]. Please confirm that you would like to log out of Medscape. Pressor agents can be used when hypotension persists following adequate fluid replacement. Accessed 6/8/2022. Because thyroid hormones affect many of your bodys functions, signs and symptoms of Graves disease can be wide ranging. Just like with all thyroid disorders, women and people assigned female at birth are more likely to experience thyroid storms than men or people assigned male at birth. However, there are some things that everyone can expect with any type of thyroid surgery. National trends in incidence, mortality, and clinical outcomes of patients hospitalized for thyrotoxicosis with and without thyroid storm in the United States, 2004-2013. Due to the rarity of this condition and its multitude of diverse presentations, diagnosis can be extremely challenging. Treasure Island, FL: StatPearls Publishing; 2021. If you experience itching, applying scar gel or aloe may provide relief, but talk to your surgeon before doing so. While temporary in some cases, hypoparathyroidism caused by the injury or removal of parathyroid glands can be permanent. Graves disease is an immune system disorder that results in the overproduction of thyroid hormones, a condition known as hyperthyroidism. PTU also blocks peripheral conversion of T4 to T3 and hence is preferred in thyroid storm over MMI. https://www.ncbi.nlm.nih.gov/books/NBK448095/. Pokhrel B, Aiman W, Bhusal K. Thyroid Storm. [7] The criteria established by Burch and Wartofsky help in early recognition of impending storm. Another theory suggests a rapid rise of hormone levels as the pathogenic source. If you had a subtotal thyroidectomy and are not immediately put on thyroid hormone medications, watch carefully for symptoms of hypothyroidism and contact your healthcare provider if they occur. [QxMD MEDLINE Link]. Fast Five Quiz: How Much Do You Know About Hyperthyroidism? [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2017 Aug. 354(2):159-64. 2012 Sep. 109(3):466-7. Clinical characteristics and outcome of thyroid storm: a case series and review of neuropsychiatric derangements in thyrotoxicosis. Symptoms and Signs of Thyroid Storm When Compared with Uncomplicated Thyrotoxicosis. The treatment strategy for thyroid storm can be divided into four general categories, including: Medications and treatment therapies for thyroid storm can include: If you have thyroid storm, youll likely be in the intensive care unit (ICU) of the hospital so your healthcare team can monitor your symptoms and condition frequently. She was discharged the following day. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. This is because post-surgical consequences often include a sore throat and such foods might enhance the level of discomfort. Peter F Czako, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, Michigan State Medical Society, American Association of Endocrine Surgeons, Detroit Surgical SocietyDisclosure: Nothing to disclose. [Full Text]. Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Propranolol produces the desired clinical response in thyroid storm only after large doses. A precipitating factor usually is found with thyroid storm. Thyroid. Congestive cardiac failure is seen as a result of impaired myocardial contractility and may require Swan-Ganz catheter monitoring. [QxMD MEDLINE Link]. You should not submerge, soak, or scrub your incision, and bathing in a tub should be avoided until you see your surgeon. 100(2):451-9. South Med J. for: Medscape. If youre experiencing symptoms, get to the nearest hospital as soon as possible. Get our printable guide for your next healthcare provider's appointment to help you ask the right questions. What You Need to Know Thyroid cancer, thyroid nodules and other conditions may require thyroidectomy. Gunateet Goswami, MD is a member of the following medical societies: American Medical Association, American Society of Echocardiography, Michigan State Medical SocietyDisclosure: Nothing to disclose. If left untreated, this may lead to multi-organ failure and death. Side effects of thyroid surgery are common and include neck pain, a sore throat, difficulty swallowing, hoarseness, and temporary hypoparathyroidism that usually resolves within a few weeks. In national surveys from the United States and Japan, the incidence of thyroid storm was 0.57 to 0.76 and 0.20 per 100,000 persons per year, respectively, and 4.8 to 5.6 per 100,000 hospitalized patients per year [ 2-4 ]. Anticoagulation drugs may be needed for atrial fibrillation and can be administered in the absence of contraindications. The iodinated x-ray contrast agent, sodium ipodate, can be administered instead of iodine and also inhibits peripheral conversion of T4 to T3. 2003 Oct;13(10):933-40 Although the exact pathogenesis of thyroid storm is not fully understood, the following theories have been proposed: Patients with thyroid storm reportedly have relatively higher levels of free THs than patients with uncomplicated thyrotoxicosis, although total TH levels may not be increased. Some causes of rapidly increased thyroid hormone levels include the following: Other common precipitants include the following: Although it can develop in toxic adenoma or multinodular toxic goiter, thyroid storm is more commonly seen in toxicity secondary toGraves disease. If calcium supplementation is not used and the condition is permanent, further symptoms may include tingling and numbness of the bottoms of the feet, muscle cramps and twitches, anxiety, depression, and headaches. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. If hoarseness persists, especially if it is still present six months after surgery, it's likely that the recurrent laryngeal nerve was injured. Please confirm that you would like to log out of Medscape. . [QxMD MEDLINE Link]. Transfus Apher Sci. Having a rapid heart rate (tachycardia) that can exceed 140 beats per minute. Before Symptoms may include an area of firmness and swelling on the front or side of the neck (usually beneath the incision), neck pain, and symptoms of airway obstruction such as shortness of breath, lightheadedness, or stridor (a high-pitched wheezing sound that's usually most noticeable with inspiration than exhalation). After improvement of thyroid function, which generally occurs within 24 hours, iodine can be gradually discontinued and glucocorticoids tapered and discontinued. Discuss what's on your mind with your healthcare provider. [QxMD MEDLINE Link]. If your healthcare provider prescribes thyroid replacement therapy, be sure to have a conversation with them before leaving the hospital about when to start the medication, which medication you need, and at what dosage. Thyroid storm. Thyroid Surgery Recovery, Side Effects, and Complications. Thyroidectomy is surgical removal of all or part of the thyroid gland, which is located in the front of the neck. Clinical thyroidology for the public. This case presentation is of a patient with PDTC complicated by functional thyroid metastases resulting in thyroid storm, which is an exceedingly rare occurrence. Confusion, agitation, delirium, frank psychosis, seizures, stupor, or coma. [QxMD MEDLINE Link]. which can make the diagnosis more difficult. [1], Thyroid storm is a decompensated state of thyroid hormoneinduced, severe hypermetabolism involving multiple systems and is the most extreme state of thyrotoxicosis. Am J Med Sci. when to consider thyroid storm . With adequate thyroid-suppressive therapy and sympathetic blockade, clinical improvement should occur within 24 hours. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. MOJ Clin Med Case Rep. 2021;11(5):136 DOI: 10.15406/mojcr.2021.11.00399.