MS in thyroid storm

Q: Altered mental status is statistically associated with mortality in thyroid storm?

A) Yes

B) No

Answer: Yes

Not all patients present with classic symptoms of thyroid storm, particularly if they are already on beta-blocker (BB) or anti-thyroid medication. They may already be in "compensated hyperthyroidism." These patients may just present with altered mental status, which is found to be statistically associated with mortality in thyroid storms. Other factors associated with high mortality are older age, mechanical ventilation, and discontinuation of anti-thyroid medication or BB.

Non-compensated thyroid storm patients may present with high grades ever. Fever of 104 to 106°F is common in thyroid storms, besides nausea, vomiting, diarrhea, abdominal pain, jaundice, lid lag, tremor, and warm moist skin.

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References:

1. Swee du S, Chng CL, Lim A. Clinical characteristics and outcome of thyroid storm: a case series and review of neuropsychiatric derangements in thyrotoxicosis. Endocr Pract 2015; 21:182.

2. Angell TE, Lechner MG, Nguyen CT, et al. Clinical features and hospital outcomes in thyroid storm: a retrospective cohort study. J Clin Endocrinol Metab 2015; 100:451.

3. Ono Y, Ono S, Yasunaga H, et al. Factors Associated With Mortality of Thyroid Storm: Analysis Using a National Inpatient Database in Japan. Medicine (Baltimore) 2016; 95:e2848.