ICU · Endocrine

Thyroid emergencies: thyroid storm and myxoedema coma

Also known as Thyroid storm (thyrotoxic crisis) · Myxoedema coma · Burch-Wartofsky score · Amiodarone-induced thyrotoxicosis

Thyroid emergencies are rare but life-threatening. THYROID STORM is the extreme manifestation of thyrotoxicosis: hyperthermia, tachyarrhythmia including atrial fibrillation, heart failure, altered mental status, precipitating event. Diagnosis is clinical (Taylor/Chiha); published cohorts have used BWS ≥45 as inclusion (Mallavarapu; Zeng score 45). Treated mortality 10-50% and untreated 80-100% (Idrose); Auer up to 30% despite treatment; Zeng perioperative series 8-25%. Management (Taylor/Kruithoff): first-line thionamide plus beta-blocker, FOLLOWED BY inorganic iodine, corticosteroids, treat precipitant, HDU/ICU; adjuncts cholestyramine, lithium, plasmapheresis, ECMO, thyroidectomy. Japanese survey: MMI in 78.1% with no mortality disadvantage vs PTU (Isozaki). MYXOEDEMA COMA: hypothermia, bradycardia, hyponatraemia, decreased GCS, hypoventilation. Mortality up to 60% (Auer); Zhang 2004-2024 overall 38.8% (271/698). Management: IV levothyroxine 200-500 mcg then 50-100 mcg daily (Myers), hydrocortisone until coexisting adrenal insufficiency is ruled out (Wall), passive rewarming, treatment of infections, respiratory and haemodynamic support.

Checked against its sources on 3 Sept 2026