Perioperative Thyroid Storm: A Medical and Surgical Emergency

Abstract

Thyroid storm is rare, acute medical endocrine emergency. It is aggressive manifestation of the hyperthyroid state. If delayed or not treated can be fatal or cause severe disabilities. Historically thyroid storm was a common complication of toxic goiter and goiter surgery but recently more common in hyperthyroidism patients with acute illness or surgical intervention and inadequately treated hyperthyroid patients. There is usually precipitating factor that lead to thyroid storm, such as emergency surgery, extreme stress, or acute severe illness. Clinical manifestations involve major body organ dysfunctions and range from fever, dysrhythmias, heart failure, vomiting, diarrhea, jaundice, and convulsions to coma. The pathophysiology of thyroid storm is organ dysfunction due to excessive thyroid hormones. Thyroid storm is diagnosed by clinical presentation, Electrocardiogram (ECG), chest X-ray findings and thyroid point of care ultrasound (POCUS), and the scoring systems. Management should be started without delay. Apart from supportive care airway, breathing, circulation, and disability (ABCD) approach and antithyroid medications should be administered. Delay in management will increase morbidity and mortality. Initially, propylthiouracil (PTU), beta-blocker, iodine, steroids, and bile chelating agent are the treatment. The thyroid mortality ranges from 20 to 30%.