Thyroid Storm

Learning Objectives

  • Recognize clinical presentation of thyrotoxicosis.

  • Describe management of thyrotoxicosis in pregnancy.

Thyroid storm and thyrotoxic heart failure are life-threatening hypermetabolic states in pregnancy. Thermoregulation, cardiovascular, nervous, and gastrointestinal systems can be affected, typically leading to multisystem failure ( Fig. 23.1 ). The key to management is to have a high index of suspicion.

Thyroid Storm Simulation

Materials Needed

  • Volunteer to act as standardized patient

Key Personnel

  • Attending obstetrician

  • Resident physician (if available in your institution)

  • Nurse

Sample Scenario

A 34-year-old G2P1 female at 32 weeks gestation presents with fever, vomiting, and “feeling like [her] heart is racing.” On exam, her pulse is 154. BP is 176/98. Temperature is 104.1. She appears agitated. You note marked exophthalmos. Fetal heart rate tracing shows baseline of 180 with minimal variability, no accelerations, and no decelerations.

– Discuss your differential diagnosis. What would be your initial work-up and management for this patient?

– As you are waiting for other lab results, her TSH results as <0.01. How do you continue to manage this patient?

Debriefing and Documentation

  • Suspected precipitating factor for thyroid storm

  • Medications received

  • Fluids received

  • Current vital signs

  • Fetal status

Precipitating Factors

  • Labor and delivery

  • Surgery

  • Trauma

  • Preeclampsia

  • Anemia

  • Sepsis


Signs and symptoms of thyroid storm are frequently nonspecific. They include the following:

  • Hyperthermia

  • Nausea

  • Abdominal pain

  • Vomiting

  • Agitation

  • Diaphoresis

  • Dehydration

  • Tachycardia

  • Congestive heart failure

  • Arrhythmia

  • Confusion

  • Cardiovascular collapse

  • Malignant exophthalmos

The diagnosis is confirmed by low TSH and elevated T4 .

Apr 6, 2024 | Posted by in OBSTETRICS | Comments Off on Thyroid Storm

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