Thyroid Storm: Causes, Symptoms, Treatment, and Cost

When the thyroid gland generates too many thyroid hormones, which results in high levels of circulating hormones in the circulation, a situation known as a 'thyroid storm' emerges.

There are no specific types of thyroid storms, but the condition can be classified based on the underlying causes or precipitating factors.

Here are some possible classifications:

• Endogenous thyroid storm: This refers to a sudden and severe exacerbation of hyperthyroidism caused by the overproduction of thyroid hormones by the thyroid gland. Factors including an illness, trauma, surgery, or mental stress might cause it.
• Exogenous thyroid storm: This refers to a sudden and severe exacerbation of hyperthyroidism caused by the intake of thyroid hormone-containing medications, such as levothyroxine or liothyronine. Misuse of these medicines or accidental or purposeful overdose may both cause it.
• Iatrogenic thyroid storm: This refers to a sudden and severe exacerbation of hyperthyroidism caused by medical interventions or procedures, such as radioactive iodine therapy or thyroid surgery. It can occur due to improper dosing or inadequate monitoring of the patient's thyroid function.
• Secondary thyroid storm: This refers to a sudden and severe exacerbation of hyperthyroidism caused by a non-thyroidal medical condition, such as a heart attack, pulmonary embolism, or diabetic ketoacidosis. These conditions can cause stress on the body and trigger the release of thyroid hormones.

An overactive thyroid gland might result in a rare but potentially fatal medical emergency known as a thyroid storm (hyperthyroidism).

The condition can be triggered by several factors, including:

• Infection: An infection can cause stress on the body, which can trigger a thyroid storm in people with hyperthyroidism.
• Surgery: Thyroid surgery or other types of surgery that involve the thyroid gland can cause a thyroid storm.
• Trauma: A thyroid storm may be brought on by trauma, such as a serious injury or vehicle accident.
• Medications: Certain medications, such as iodine-containing contrast agents used in imaging tests, can cause a thyroid storm in people with hyperthyroidism.
• Pregnancy: Women who already have hyperthyroidism may have thyroid storms due to hormonal changes brought on by pregnancy.
• Thyroiditis: Inflammation of the thyroid gland, also known as thyroiditis, can cause a thyroid storm.
• Withdrawal from thyroid hormone replacement therapy: Stopping or reducing thyroid hormone replacement therapy can cause a thyroid storm in people with hypothyroidism.

The symptoms of thyroid storm include:

• Abnormally high heart rate and blood pressure
• Fever
• Sweating
• Palpitations
• Confusion
• Restlessness
• Tremors or seizures
• Other symptoms may include weight loss, diarrhea, vomiting, or jaundice.

Several prevention methods can be taken to prevent thyroid storm, including:

• Proper management of underlying thyroid conditions, such as hyperthyroidism
• Regularly monitoring thyroid hormone levels
• Avoiding triggers such as stress, infections, and iodine-containing medications
• Taking prescribed medications as directed by a healthcare provider
• Maintaining a healthy lifestyle with a balanced diet and regular exercise
• Seeking immediate medical attention if symptoms of thyroid storm occur.

Here are some of the diagnostic tests that may be performed to confirm the diagnosis of thyroid storm:

• Thyroid function tests: These tests measure the levels of thyroid hormones (T3 and T4) and thyroid-stimulating hormone (TSH) in the blood. In thyroid storms, the levels of T3 and T4 are usually elevated, and the TSH level is low or undetectable.
• Electrocardiogram (ECG): This test captures the heart's electrical activity and may identify irregularities including tachycardia, arrhythmia, and ischemia that may manifest during thyroid storms.
• Chest X-ray: This test may be done to evaluate lung function and detect any signs of pulmonary edema or other respiratory complications.
• Blood tests: A complete blood count (CBC), electrolyte panel, liver and kidney function tests, and coagulation studies are some of the procedures that may be performed. They may aid in identifying any underlying medical issues that can aggravate or worsen thyroid storms.
• Imaging tests: These tests may include computed tomography (CT) or magnetic resonance imaging (MRI) of the brain or other organs to detect any abnormalities or complications.
• Thyroid ultrasound: The thyroid gland is imaged using high-frequency sound waves in this examination, which may assist estimate its size and form as well as spotting any nodules or other abnormalities.
• Radioactive iodine uptake (RAIU) test: This examination evaluates the thyroid's uptake of iodine and may provide information about the thyroid's degree of activity.

Complications related to Thyroid storm include:

• Cardiovascular complications: Thyroid storms can cause a rapid and irregular heartbeat, high blood pressure, and heart failure. Serious side effects including a heart attack, stroke, or pulmonary edema may result from this.
• Central nervous system complications: The thyroid hormones can affect the brain and nervous system, causing confusion, agitation, seizures, and coma.
• Gastrointestinal complications: Thyroid storm can cause nausea, vomiting, diarrhea, and abdominal pain. In extreme circumstances, it may result in bowel blockage, perforation, or gastrointestinal hemorrhage.
• Metabolic complications: The high levels of thyroid hormones can cause a rapid increase in metabolism, leading to weight loss, dehydration, and electrolyte imbalances. This can result in kidney failure, liver failure, or diabetic ketoacidosis.
• Respiratory complications: Thyroid storms can cause shortness of breath, respiratory distress, and acute respiratory failure. Particularly in people with underlying lung illness, this may be fatal.
• Endocrine complications: Thyroid storm can cause a variety of endocrine disorders, including adrenal insufficiency, hypoglycemia, and hypothyroidism.
• Infection complications: Since their immune systems are compromised, patients with thyroid storms are more likely to become sick. This can lead to sepsis, pneumonia, or other serious infections.
• Psychiatric complications: Thyroid storms can cause mood swings, anxiety, and depression. In extreme circumstances, it could cause psychosis or thoughts of suicide.

Some of the home remedies advised to the patients of Thyroid storm:

• Ashwagandha: It is a powerful herb that helps in regulating the thyroid gland and balance hormones. It may be taken as churn or taken as pills.
• Guggulu: It is a resin extracted from the Commiphora wightii tree, and it is an effective remedy for treating thyroid disorders. It may be consumed as churn or in capsule form.
• Kanchanar Guggulu: It is an Ayurvedic formulation made from a combination of herbs that help in regulating the thyroid gland and balance the hormones. It may be consumed as churn or as pills.
• Triphala: It is made up of three fruits—amla, haritaki, and bibhitaki—and aids in digestion and bodily detoxification. It may be taken orally as powder or pills.
• Brahmi: It is a herb that helps in reducing stress and anxiety, and it also helps in improving cognitive function. It may be taken orally as powder or pills.
• Turmeric: It is a spice that has anti-inflammatory properties and helps in reducing inflammation in the body. It may be taken orally, as a powder, or by mixing it with food.
• Lemon balm: It is a herb that helps in reducing stress and anxiety, and it also helps in improving sleep. It may be taken orally as capsules or as tea.
• Ashoka: It is a plant that aids in menstrual cycle regulation and lessens thyroid problem symptoms. It may be taken orally as powder or pills.

Foods to include in the diet of patients with Thyroid storm:

• Foods that are rich in antioxidants such as fruits and vegetables can be eaten in thyroid storms. These nutrients assist in scavenging the thyroid-damaging free radicals.
• Iodine-rich foods should be avoided since they might make thyroid storm symptoms worse. Seafood, seaweed, and iodized salt are some examples of iodine-rich meals.
• Milk, cheese, and yogurt are examples of low-fat dairy products that are excellent providers of calcium and vitamin D, both of which are vital for strong bones. In moderation, these items may be included in the diet.
• You may consume lean protein sources during thyroid storms, such as fish, tofu, chicken, and turkey. These meals provide the vital amino acids that the body needs for development and repair.
• Whole grains are a rich source of fiber, which may aid in regulating digestion and preventing constipation. Examples of such grains are brown rice, quinoa, and whole-wheat bread.
• In a thyroid storm, small, frequent meals might be beneficial. Eating several small meals throughout the day can help to maintain energy levels and prevent blood sugar fluctuations.
• Caffeine and sugar-rich foods should be avoided since they might make thyroid storm symptoms worse. These foods include coffee, tea, soda, and candy.
• In a thyroid storm, it's critical to maintain your fluid intake. Maintaining normal physiological functioning and preventing dehydration may both be achieved by drinking enough water and other liquids.

These foods should be avoided in patients with Thyroid storm:

• Iodine-rich foods: Foods high in iodine such as seaweed, seafood, and iodine-fortified foods should be avoided as they may worsen thyroid storm symptoms.
• Soy products: Soy products like soy milk, tofu, and other soy-based products should also be avoided as they can reduce the absorption of thyroid medication.
• Caffeine and alcohol: These should be avoided as they can exacerbate symptoms such as rapid heartbeat and increased blood pressure.
• Processed and fried foods: These foods are usually high in trans fats and can increase inflammation in the body, which may exacerbate thyroid storm symptoms.
• Sugary foods and refined carbohydrates: Blood sugar fluctuations brought on by these meals might exacerbate symptoms like weariness and mood changes.
• Dairy products: High-fat dairy products like cheese and butter should be avoided as they can interfere with the absorption of thyroid medication.
• Gluten-containing foods: Some people with thyroid problems may have an autoimmune condition called celiac disease, which also involves a gluten intolerance. In these cases, avoiding gluten-containing foods may help to manage symptoms.

Treatments for Thyroid storm include:

• Stabilization: The first step in treating thyroid storm is to stabilize the patient's vital signs. To regulate heart rate, blood pressure, and body temperature, this may include giving an individual oxygen, water, and drugs.
• Glucocorticoids: Glucocorticoids are used to reduce inflammation and stabilize the patient's immune system. Medications such as hydrocortisone or prednisone may be used.
• Iodine therapy: Iodine therapy is used to reduce the production of thyroid hormones. This can include taking drugs like potassium iodide or Lugol's solution.
• Total thyroidectomy: To cease the production of thyroid hormone, the complete thyroid gland must be removed. This is the preferred treatment for thyroid storms caused by conditions like Graves' disease, toxic multinodular goiter, or thyroid cancer.
• Subtotal or partial thyroidectomy: This involves the removal of only a portion of the thyroid gland, leaving a small amount of functioning tissue intact. This surgery may be considered for patients with less severe hyperthyroidism or those at higher risk of complications from total thyroidectomy.
• Thyroid artery embolization: This is a minimally invasive procedure where an interventional radiologist injects tiny particles into the arteries that supply blood to the thyroid gland, thereby reducing its blood flow and function.
• Radioactive iodine therapy: This is not a surgical procedure, but it involves the ingestion of radioactive iodine, which selectively destroys the thyroid gland tissue. This may be an alternative to surgery for patients who are not surgical candidates or prefer not to have surgery.

You should consult these doctors in case of a Thyroid storm:

• Endocrinologist - As a thyroid storm is primarily caused by hyperthyroidism, consulting an endocrinologist is essential. They can develop a successful treatment strategy that addresses the underlying disease since they are specialists in identifying and treating hormone abnormalities.
• Intensivist - Since a thyroid storm is a medical emergency, it is vital to consult an intensivist as they specialize in critical care management. They can help stabilize the patient's condition, manage complications, and monitor vital signs.
• Cardiologist - Thyroid storm can lead to a rapid increase in heart rate and severe cardiovascular complications. A cardiologist can assess the patient's heart function and provide appropriate cardiac care throughout their treatment.
• Neurologist - In severe cases, a thyroid storm can cause neurological symptoms such as confusion, seizure, and coma. A neurologist can help manage these symptoms and monitor any potential complications related to the brain's function.
• General Practitioner - Initially, a general practitioner may diagnose and manage the patient's symptoms before referring them to a specialist. They can also provide guidance and ongoing care throughout the recovery process.

Drugs and medications that are important for treating thyroid storm include:

• Antithyroid drugs such as propylthiouracil and methimazole, work to block the production of thyroid hormone
• Beta-blockers like propranolol, help to control the symptoms associated with thyroid storms, such as rapid heart rate and anxiety
• Corticosteroids are used to reduce inflammation and swelling in the thyroid gland. Intravenous fluids are given to help maintain hydration and electrolyte balance
• Intravenous fluids are given to help maintain hydration and electrolyte balance
• In addition to these medications, it may also be necessary to provide supplemental oxygen, monitor electrolyte levels, and provide supportive care to address any other complications that may arise.

The time period for recovery from a thyroid storm varies depending on the severity of the condition and the effectiveness of treatment:

In some cases, patients may recover within a few days to a week, while in others it may take several weeks or even months.

Close monitoring and management of symptoms, as well as proper medication and supportive care, can help speed up the recovery process.

No, the results of the treatment for thyroid storm may not be permanent, as the underlying condition that caused the thyroid storm may still exist.

After treatment for thyroid storm, the patient should follow these post-treatment steps:

• Take all prescribed medications as directed by the doctor, including beta-blockers, antithyroid drugs, and corticosteroids.
• Attend all subsequent sessions with the physician to monitor thyroid hormone levels and modify dosages as necessary.
• Monitor symptoms and report any changes or concerns to the doctor.
• To maintain general health and control weight, keep up a nutritious diet and do routine exercise.
• Avoid stress and get adequate rest to reduce the risk of triggering another thyroid storm episode.
• If you want to handle the emotional effects of the disease, think about joining a support group or getting therapy.
• Educate family members and close friends about the condition and its symptoms, so they can recognize and respond appropriately in case of an emergency.

The cost of treatment for thyroid storm in India can vary depending on the hospital and the severity of the condition:

On average, hospital expenses can range from Rs. 50,000 to Rs. 2 lakhs. This includes the cost of hospital room, medication, diagnostic tests, and doctor's fees.

If the patient needs critical care or surgery, the cost could be greater in specific circumstances.

Common side effects of Thyroid storm include:

• Heart problems: Treatment for thyroid storm can cause heart-related problems such as palpitations, irregular heartbeats, and an increased heart rate.
• Nervousness and anxiety: Over-treatment of the condition can cause nervousness and anxiety, which can also lead to irritability, mood swings, and other psychological issues.
• Fever and sweating: The treatment may cause an increase in body temperature, leading to excessive sweating and fever.
• Weakness and fatigue: Treatment for thyroid storm can also lead to extreme fatigue and weakness, making it hard for people to perform regular activities.
• Nausea and vomiting: In addition to digestive problems including nausea and vomiting, thyroid storm treatment may also induce these.
• Tremors: An overactive thyroid or during its over-treatment can cause tremors in the body.
• Insomnia: The treatment can cause excess nervousness and heart issues, and hence insomnia can become a problem.
• Liver dysfunction: Some medications used in the treatment of thyroid storm can hurt the liver.
• Blood pressure issues: Overactive thyroid or over-treatment can also lead to irregular blood pressure issues.
• Skin conditions: The treatment can sometimes result in skin rashes, itching, and other skin problems.

You should see a local doctor if you have any thyroid storm consequences since they may include 'cardiovascular complications, Gastrointestinal difficulties, etc.,' and depending on how serious they are, the appropriate course of therapy might take anywhere from a few months to years.