Which factors increase the mortality risk of thyroid storm, and what decreases the mortality rate in thyroid storm-related coma?

Updated: Mar 16, 2020
  • Author: Madhusmita Misra, MD, MPH; Chief Editor: Robert P Hoffman, MD  more...
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With adequate thyroid-suppressive therapy and sympathetic blockade, clinical improvement should occur within 24 hours. Adequate therapy should resolve the crisis within a week. Treatment for adults has reduced mortality to less than 20%. In one retrospective study from Japan of 1324 patients who were diagnosed with thyroid storm, the overall mortality was 10%. [9]  In the same study, the following factors were associated with increased mortality risk in thyroid storm [9] :

  • Age 60 years or older
  • Central nervous system (CNS) dysfunction at admission
  • Lack of antithyroid drug and beta-blockade use
  • Need for mechanical ventilation and plasma exchange along with hemodialysis

In addition, a study by Swee et al of 28 patients with thyroid storm reported that CNS dysfunction of greater than mild severity appeared to be a risk factor for mortality. [10]

A retrospective study by Bourcier et al of 31 French intensive care units (ICUs) found that in ICU patients with thyroid storm, multiple organ failure (as evaluated using the Sequential Organ Failure Assessement [SOFA] score, absent the cardiovascular component), and the occurrence, within 48 hours following ICU admission, of cardiogenic shock are independent risk factors for mortality in the ICU. [11]

A study by Burmeister reported a mortality rate of 38% in patients with thyroid storm–related coma, including 70% between 1935 and 1977, and 11% between 1978 and 2019. The investigator found that there was a greater tendency for patients to awaken from their coma when total and free T4 values, and possibly the total T3 value as well, was reduced. Moreover, the employment of antithyroid drugs, corticosteroids, beta blockers, and intubation correlated positively with lower death rates. Although plasmapheresis-related awakenings occurred in 67% of patients in which plasmapheresis was used, the procedure was not linked to a reduction in the death rate. [12]

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