Thyroid storm pathophysiology explores the underlying causes and course of a rare thyroid condition.

A thyroid storm is a potentially deadly condition, where thyroid hormones elevate rapidly. It can cause a high fever, changes in heartbeat, and other symptoms. Early detection and treatment can help improve a person’s outcome.

This article explains what thyroid pathophysiology is and includes its symptoms, causes, and more.

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Pathophysiology contains three Greek root words that help explain its meaning. These include:

  • pathos, which means “suffering”
  • physis, meaning “origin”
  • logos, which means “the study of”

Put together, it is the study of the origin of a person’s suffering or disease. Pathophysiology is the study of abnormal changes that cause a disease, come about because of a disease, or occur due to a related or associated condition.

Researchers in pathophysiology typically attempt to identify biomarkers, which can aid in processes, such as diagnoses and potential treatments. They also seek to understand the underlying mechanisms of a disease to better explain its causes and development, as well as to predict outcomes.

Thyroid storm pathophysiology is the study of the underlying causes and processes of a thyroid storm.

Researchers still do not understand the exact underlying cause of thyroid storms. It is a potentially life threatening complication of hyperthyroidism.

Scientists have presented several hypotheses to explain how thyroid storms develop.

One hypothesis suggests that a thyroid storm occurs due to a rapid increase of thyroid hormones instead of the absolute amount a person accumulates. This may occur following thyroid surgery, discontinuation of thyroid medications, or other acute events.

Another hypothesis proposes that a thyroid storm may occur due to hyperactivity of the sympathetic nervous system — part of the autonomic nervous system often known for the fight or flight response — and an increased sensitivity of cells to thyroid hormones.

Preceding events for this may include acute infections or stress that cause the release of cytokines — proteins that help immune cells grow and activate — and an altered immune system response.

However, an increased level of thyroid hormones is not likely responsible for a thyroid storm. A person may have an elevated level of thyroid hormones and never experience a thyroid storm.

The most common symptoms of a thyroid storm include:

A thyroid storm can affect different organs and systems. This can cause additional symptoms and complications, such as congestive heart failure, liver damage, or trouble breathing.

Rarely, a person may experience a form of thyroid storm known as an apathetic storm. When this occurs, a person may experience symptoms, such as:

  • emotional apathy
  • an absent or low fever
  • extreme weakness
  • confusion

Scientists know that a thyroid storm occurs following a preceding event.

Some possible events that can trigger a thyroid storm include:

  • thyroid surgery
  • giving birth
  • suddenly stopping thyroid medication
  • non-thyroid surgery
  • trauma
  • radioiodine therapy, rarely
  • acute illnesses or events, such as:
  • burns
  • recent use of an iodinated contrast medium
  • medication side effects, such as from anesthetics, salicylates, or amiodarone
  • severe nausea and vomiting during pregnancy
  • stroke
  • traumatic brain injury

Living with some underlying conditions may increase a person’s risk of having a thyroid storm. Some possible conditions can include Graves’ disease and other causes of hyperthyroidism, such as toxic thyroid adenoma.

A thyroid storm can cause death in about 10 to 25% of people who experience them. Early recognition and treatment can improve a person’s outcome.

Due to the rarity of the condition, very few studies examine or provide treatment recommendations. Instead, expert opinions typically drive treatment decisions.

Doctors need to treat both the thyroid storm, as well as any underlying cause of the storm. Treatment often occurs in an intensive care unit.

Direct care for the thyroid storm helps control the thyroid and reduce hormone levels. They may include:

People living with Grave’s disease may require surgery. Surgery is typically done 5 to 7 days after pretreatment with medications.

Supportive care to help treat symptoms or complications may include:

  • mild sedation
  • rest
  • electrolyte and fluid replacement
  • oxygen therapy
  • cardio support, as needed
  • antibiotics
  • nutritional support and vitamins, as needed
  • fever control
  • other therapies, as needed

A person cannot treat a thyroid storm at home and should seek emergency care as soon as possible if they experience unusual symptoms, such as a high fever.

The following sections provide answers to frequently asked questions about thyroid storms.

What is the difference between thyrotoxicosis and a thyroid storm?

Experts describe a thyroid storm as an exaggerated form of thyrotoxicosis. Thyrotoxicosis is a clinical state associated with high levels of thyroid hormones circulating throughout the body.

Symptoms associated with milder forms of thyrotoxicosis occur due to metabolic changes. They can include:

What are the five B’s of a thyroid storm?

The five B’s of a thyroid storm reference five important parts of treatment. They include:

  • block synthesis, using antithyroid drugs
  • block release, using iodine
  • block T4 into T3 conversion, using high dose propylthiouracils, such as propranolol, corticosteroid, and amiodarone (rare)
  • beta-blocker use
  • block enterohepatic circulation, using cholestyramine

Thyroid storms are potentially life threatening events that occur when the level of thyroid hormones increases rapidly. They occur following an event, such as an infection, surgery, or the discontinuation of thyroid medication.

Symptoms can include fever, delirium, changes in the heartbeat, and others. It can lead to complications involving different organs, such as the heart and liver.

Treatment involves stopping thyroid hormone activity and providing supportive care for the person. With prompt treatment, a person’s outlook increases.