How does thyrotoxic storm occur during thyroidectomy and how is it managed?

Updated: May 08, 2018
  • Author: Neerav Goyal, MD, MPH; Chief Editor: Arlen D Meyers, MD, MBA  more...
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One of the contraindications for thyroidectomy is a patient with untreated or uncontrolled Graves disease or hyperthyroidism. One of the rarer complications from thyroid surgery is precipitation of a thyroid storm, which can occur intraoperatively or postoperatively. It is thought to occur secondary to thyroid gland manipulation in the operating room in patients with hyperthyroidism. Manifestations include tachycardia, hyperthermia, cardiac arrhythmias, and increased sympathetic output. Awake patients also present with nausea and altered mental status. If untreated, it may precipitate coma and death.

Intraoperatively, if signs of a thyrotoxic storm develop, the case needs to be halted and the patient needs to be medically managed to reduce sympathetic output. Cooling blankets, beta-blockers, PTU, and iodine should be administered.

Postoperatively, the patient may still have signs of thyrotoxicosis and should be continued on preventative medication. Medications can be weaned as thyroid hormone levels decrease.

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