What is the role of surgery in the treatment of thyroid storm?

Updated: Feb 18, 2018
  • Author: Madhusmita Misra, MD, MPH; Chief Editor: Robert P Hoffman, MD  more...
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Answer

In rare patients with hyperthyroidism, thyroid artery embolization has been used as adjuntive therapy [20, 21, 22] .  In one case series, this strategy caused an increase in thyroid hormone levels over the first three days following embolization followed by a subsequent reduction in levels (with normalization in nine out of twelve patients by 12 weeks), but the majority did not achieve permanent remission [22] .  In one reported case of a 64 year old man in whom thyroid hormone levels remained elevated and the patient remained unstable despite steroids, a thionamide, beta blockers and plasmapheresis, thyroid artery embolization was performed as the patient had contraindications to radioactive iodine and surgery [21] . Thyroid hormone levels increased over the first 2-3 days, but decreased from baseline after a week of the procedure. The goal of embolization in this patient was to cause atrophy, but not acute necrosis of the gland given the risk of thyroid storm with the latter. Subsequently, the patient's clinical condition improved and he was able to undergo a thyroidectomy.


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