Storm resuscitation sequences, operating through thyrotoxicosis, and haematoma vigilance arithmetic

(A) Storm is multi-organ failure with triggering illness — resuscitate multimodally in intensive care with antithyroid drugs, iodide, steroids and blockade per the 15-recommendation Japan framework built from 356 patients dying near one in ten.^[1] Adherence halves death: the 110-patient prospective registry at worse physiology cuts day-30 mortality to 5.5% against 10.7% historically.^[2] Block by context: 2,462 patients show selective blockade matching propranolol on adjusted death at 6.3% against 7.4% — both viable.^[4] Withhold early steroids for survival: 811 intensive-care patients show no mortality gain with higher insulin use.^[5] Bridge the untreatable with plasma: 19 patients at a median four sessions with significant hormone falls and 10 reaching thyroidectomy without adverse events.^[6]

(B) Operate through thyrotoxicosis when drugs fail: 275 patients at half uncontrolled with zero surgically precipitated storm in either arm — actively thyrotoxic thyroidectomy is safe.^[8] Rescue carries its own numbers: 30 urgent thyroidectomies for medication failure and worsening failure with 6.7% haematoma reoperation and one death in thirty.^[7]

(C) Watch six hours with risk arithmetic: REDHOT counts 3.15% haematoma with 0.79% revised across 8,839 patients and 74% of revisions inside six hours — male, older, heavier, dissected, drained and quicker cases independently risky, monitored six hours and excluded from day-case.^[14]