by Joyce Good Henderson

Created on: August 29, 2011   Last Updated: September 02, 2011

A thyrotoxic crisis, also called a thyroid storm, much like the perfect storm, occurs when  chronic overproduction of the thyroid hormones meets a sudden, severe illness, infection or trauma. This rare and serious complication of hyperthyroidism produces a life-threatening situation.

The thyroid gland produces two hormones: T3 and T4. When overproduction occurs, whether because of an illness or inappropriate medication, the body responds with an increase in the metabolic rate. You can experience the symptoms of hyperthyroidism for a long period of time without the complication of a thyroid storm. The symptoms are easily missed or misdiagnosed.

If you are dieting, you may welcome a boost to your weight loss along with changes in appetite. Anxiety, irritability, hyperactivity, fatigue and weakness are easily dismissed as the results of a stressful lifestyle. Sweating, heat intolerance, changes in libido, and hair loss can be blamed on mid-life female hormone changes. Palpitations, changes in the heart rhythm and shortness of breath can be related to a heart problem. However, over time, the increased metabolic rate can stress the body, especially the heart, gastrointestinal and sympathetic nervous systems, leading to greater susceptibility to a thyroid storm.

The onset of a thyroid storm is usually marked by an abrupt event such as a trauma, infection or surgery, an episode of insulin-induced diabetic hypoglycemia, a stroke or heart attack, a pulmonary blood clot, the sudden discontinuation of thyroid medication, or a pregnancy complication called pre-eclampsia. Thyroid surgery with improper replacement of thyroid hormones can produce a thyrotoxic crisis.

The classic symptom of a thyroid storm is a marked elevation in temperature, as high as 105-106 ºF (40.5-41.1 C).  The flushed, warm skin accompanying a fever soon exacerbates to a critical hyperthermia. You may experience a rapid heart rate, impending vascular system collapse with chest pain and shortness of breath, vomiting, diarrhea, tremor and weakness, visual disturbances, restlessness and loss of consciousness.

If you suspect you are experiencing a thyroid storm, seek immediate emergency treatment. Quick diagnosis and aggressive, emergency treatment has brought death rates down from 100% to about 20%. Managing a thyroid storm requires monitoring your vital signs, especial your heart ECG and pulmonary status. The first steps in treatment involve lowering the circulating thyroid hormones with medications such as Propylthiouracil and methimacil, then blocking the thyroid from producing more hormones using potassium iodide or Lugol’s solution. Beta blocking drugs help to control a rapid heart rate and corticosteroids stop T3, from converting to T4. 

Managing a thyroid storm also involves supportive therapy aimed at lowering the body temperature, providing intravenous fluids to support the cardiovascular system, and sedatives, as needed.

While the symptoms of hyperthyroidism can often be traced back several months in hindsight, a thyroid storm occurs suddenly, without warning and quickly becomes life-threatening. Recognizing it as an emergency, and seeking immediate medical attention can prevent a thyrotoxic crises from becoming fatal.

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