For the assessment and treatment of thyroid storm, check out the latest guidelines!

Thyroid storm, also known as hyperthyroidism, manifests as a sudden exacerbation and exacerbation of hyperthyroid symptoms, characterized by multisystem involvement, which can be life-threatening, and multi-organ failure is a common cause of death, requiring early recognition and urgent treatment

The Burch-Wartofsky Score Scale (BWPS) is currently widely used in the diagnosis of thyroid storm, including body temperature, cardiovascular system, central nervous system, digestive symptoms, and the presence or absence of identified precipitating factors

A BWPS score of ≥45 suggests thyroid storm that requires aggressive treatment; 25 to 44 are divided into prethyroid crisis, so the sensitivity of the score is high and the specificity is low, so it should be based on clinical judgment on whether to use aggressive treatment; A score of 25 < does not indicate thyroid storm

Thyroid storm has a high mortality rate and should be identified early and actively combined.

Thyroid storm medications and dosages

Antithyroid drugs (ATDs) should be used as soon as possible, preferably propithiouracil (PTU), PTU, or methamisole (MMI) at a recommended dose of 600 mg/day or 60 mg/day, with doses adjusted according to individual circumstances, with a maximum dose of PTU of 1 600 mg/day and a maximum MMI of 120 mg/day

Corticosteroid therapy, such as hydrocortisone 50 to 100 mg IV every 6 to 8 h, or dexamethasone 2 mg IV every 6 to 8 h, should be gradually reduced and discontinued

In patients with thyroid storm with tachycardia, it is recommended to control the heart rate with β-blockers, such as propranolol 60 to 80 mg, orally every 4 to 6 hours
.

Intravenous esmolol can achieve a faster effect, with a loading dose of 0.
25 to 0.
5 mg/kg, followed by continuous infusion
at a rate of 0.
05 to 0.
1 mg·^kg-1·^min-1.

However, in the presence of heart failure, the use of β-blockers requires close monitoring of hemodynamics, and selective beta-1-blockers such as metoprolol or atenolol can be used, which is contraindicated in
severe heart failure.

Symptomatic treatments such as cooling, sedation, and correction of water-electrolyte abnormalities are important
.

In addition, fever requires vigilance against infection and prompt anti-infective treatment
.

Plasmapheresis should be considered when the results of the above conventional treatment are not satisfactory
.

For patients with multiple organ failure, a combination of TPE and continuous hemodialysis filtration
is recommended.

Prevention of thyroid storm includes identifying and actively avoiding common precipitating factors, avoiding abrupt interruptions in ATDs, and trying to ensure that patients function normally
during possible stressful states such as elective surgery and childbirth.

Recommendation: Patients with thyroid storm should be treated with aggressive combination therapy, including ATDs, β-blockers, inorganic iodides, glucocorticoids, nutritional support, treatment for triggers, and respiratory and cardiac monitoring
.

(Strong recommendation, low-quality evidence)

The above content is excerpted from: Chinese Medical Association Endocrinology Branch, Chinese Medical Doctor Association Endocrinology and Metabolism Physician Branch, Chinese Medical Association Nuclear Medicine Branch, et al.
Guidelines for the Diagnosis and Treatment of Chinese Hyperthyroidism and Other Causes[J].
Chinese Journal of Endocrinology and Metabolism, 2022, 38(8): 700-748.