Thyroid storm: a Japanese perspective.

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Thyroid storm: a Japanese perspective.

Thyroid. 2017 Sep 13;

Authors: Akamizu T

Abstract
BACKGROUND: Thyroid storm (TS) is life threatening. In the mid-2000s, its incidence was poorly defined, peer-reviewed diagnostic criteria were not available, and management and treatment did not seem to be verified based upon evidence and latest advances in medicine.
METHODS: We first developed diagnostic criteria based on 99 patients in the literature and our 7 patients. We then conducted initial and follow-up surveys from 2004 through 2008, targeting all hospitals in Japan to obtain and verify information on patients who met diagnostic criteria for TS. Based on these data, we revised the diagnostic criteria and created management and treatment guidelines.
RESULTS: We estimated the incidence of TS in hospitalized patients in Japan to be 0.20 per 100,000 per year and 0.22% of all thyrotoxic patients. The mortality rate was 10.7%. Multiple organ failure was the most common cause of death, followed by congestive heart failure, respiratory failure, and arrhythmia. In our final diagnostic criteria for TS, we added the definition of jaundice as serum bilirubin concentration >3 mg/dL. Based upon the nationwide surveys and the latest information, guidelines for the management and treatment for TS were extensively revised and algorithms were developed.
CONCLUSIONS: TS remains a life-threatening disorder with over 10% mortality in Japan. We present new peer-reviewed diagnostic criteria for TS and clarify its clinical features, prognosis, and incidence based on nationwide surveys. Furthermore, this information helped establish detailed guidelines for the management and treatment of TS. A prospective prognostic study to validate the guidelines is eagerly anticipated.

PMID: 28899229 [PubMed - as supplied by publisher]

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