The human body is designed in a very intricate and well-controlled manner. Even the mildest aberration in the normal functioning or levels of some micro nutrients as well as neurotransmitter may prove life threatening, so it is absolutely necessary to have a normal balance and state of equilibrium within the body. With the hyper-secretion of thyroid hormone, this gland is potentially among the most dangerous glands of our bodies. The primary function of thyroid gland is to maintain the rate of metabolism and the normal body temperature. However, sometimes severe consequences may occur due to abnormal functioning of the thyroid gland. One such example is hyper-functioning of thyroid and resulting extreme state of Thyrotoxicosis, also known as thyroid storm.
What is a thyroid storm?
Thyroid storm is referred to as a disorder of thyroid gland in which severe and life threatening consequences may occur, due to metabolic and toxic effects of this very small gland that is located in the neck region. It is an acute disorder that exerts its effects within minutes and may proves life threatening in some extreme cases.
Thyroid storm is a state of extremely high metabolic activity that affects the integrity of all major and vital organs. The alarmingly high levels of metabolism are achieved due to excessively the heightened secretion of thyroid glands. The individuals suffering from the thyrotoxicosis suffer from the problem of excessively high levels of secretion of the thyroid hormones.
Clinical Presentation of Thyroid Storm
Thyroid storm is normally seen in the initial phase of thyrotoxicosis, a state of hyper-secretion of the main hormone of thyroid gland, which is thyroxin. The clinical presentation of this disease is characterized by fever, hypertension that is extremely and abnormally high and other neurological abnormalities, discussed in detail below.
Since thyroid hormone has its receptors on most parts of the body but the richest concentration is present on heart and vasculature. So, if the level of thyroid hormone in the blood increases and passes beyond a certain limit, high blood pressure will result. In some severe cases, when hypertension rises to extreme levels, it may result in the heart failure and congestive problems. This is because thyroid hormones have their receptors on the heart tissue and in case of excessive thyroid activity on heart, left heart failure may ensue that leads to hypotension (as heart is no longer pumping any blood in the periphery). The diagnosis and treatment of thyroid storm is absolutely necessary in order to save the life of patients. Apart from heart failure, rhythm abnormalities are also extremely common, which leads to characteristic symptoms of palpitation and anxiety, hallmark of thyroid storm.
Due to hyper-functioning and release of thyroid hormones, the gut becomes overly sensitive and profuse watery diarrhea is seen. Apart from diarrhea, severe nausea, vomiting, electrolyte abnormalities, profuse sweating and other findings may also be seen. With long standing and untreated cases, alteration in liver enzymes is also seen that manifest as jaundice.
Generally, patients of thyroid storm are very anxious, irritable and nervous. You can easily check tremors and jerky movements of the face, limbs and tongue. All these actions are manifested by high thyroid levels on the beta receptors.
Therefore rapid diagnosis, treatment and recovery are extremely crucial in these cases. However it is fortunate that this condition is not observed very frequently at initial stages of disease.
Diagnosis of Thyroid Storm
Diagnosis of the thyroid storm is mainly done through clinical procedures. There are a number of laboratory tests available for the diagnosis of the thyroid storm. The most commonly used is Thyroid hormone levels test which shows weather or not their levels are high. Likewise, some labs also conduct the levels of TSH hormone in order to access the location of pathology. In most cases, if the pathology is within the thyroid gland in the form of an adenoma, you will see extremely low to negligible levels of TSH.
Causes of thyroid crisis:
Thyroid storm is a decompensated state of thyroid hormone–induced, severe hyper-metabolism involving multiple systems and is the most extreme state of thyrotoxicosis. The clinical picture relates to severely exaggerated effects of thyroid hormone due to:
Increased release that may be unprovoked or provoked. Primarily seen in the setting of excessive synthesis in the presence of a toxic adenoma.
Rarely, increased intake of thyroid hormone as a weight loss therapy or in individuals who are suffering from hypothyroidism and consuming exogenous thyroxin as a part of therapy.
In most people, an episode of thyroid storm is normally seen just after or during the thyroid procedure (most commonly during surgeries for thyroid adenoma). This is because during any surgery the secretion of thyroid gland and adrenal glands is increased that may lead to a critical medical emergency if not timely treated. Currently, most doctors prescribe medications like Beta-blockers to prevent the action of excessive thyroid hormone on the beta receptors.
The treatment of thyroid crisis is mostly supportive to bring down the body temperature and to control the high blood pressure before it could lead to a potentially life threatening episode. This may be pulmonary edema or even a brain hemorrhage. Most doctors imply a slow approach for fever by starting anti-pyretic therapy like acetaminophen or aspirin. However, if the patient is relatively young, other methods are more commonly employed due to potential risk of Reye syndrome with aspirin or liver failure with acetaminophen. In order to control the heart rate and rhythm, the most commonly used drugs are beta blockers that control the extra cardiac symptoms by blocking the action of thyroxin.
Thyroid storm as discussed before is a complication of thyrotoxicosis that may be because of a temporary medical issue like after a viral infection, or may occur as a result of more serious illness like adenoma or cancer. In any such case, it is important to treat the main issue in order to avoid the recurrent episodes of thyroid storm. In long standing cases, several other complications may also ensue besides thyroid storm that includes but are not limited to depression, loss of hair as a result of damage to metabolic activities of the body. In case of thyroid storm the chances of returning to basal heart functioning are fairly high, but in long standing cases, irreversible damage to heart muscle lead to permanent rhythm abnormalities. Lastly, osteoporosis or permanent damage to bones and calcification of other body organs, as a result of aberrations in calcium metabolism are also additional complications of long standing cases of hyperthyroidism.