A fictional 36-year-old with untreated thyrotoxicosis presents with fever, agitation, diarrhoea, atrial fibrillation and heart failure features.
Frame the danger first.
- Thyroid storm is a clinical diagnosis of decompensated thyrotoxicosis; do not wait for hormone results to escalate.
- Fever, delirium, marked tachycardia, heart failure and gastrointestinal symptoms can coexist.
- Look for infection, surgery, medicine non-adherence or other precipitants.
Act, escalate, reassess.
- Use ABCDE and involve senior endocrinology and critical care immediately.
- Treat physiological complications and seek the current local endocrine emergency regimen.
- Investigate and manage the precipitant in parallel with supportive care.
- Monitor cardiac rhythm, temperature, fluid balance, liver function and neurological state closely.
Red flags that change pace.
- Shock, pulmonary oedema, malignant arrhythmia or severe heart failure
- Hyperthermia, delirium, seizure or reduced consciousness
- Rapid deterioration despite initial physiological support
What makes care less safe.
- Waiting for thyroid-function results before escalating
- Using remembered treatment sequences rather than the current protocol
- Ignoring a precipitant such as sepsis or acute coronary syndrome
Say the concern plainly.
Possible thyroid storm: thyrotoxicosis history [summary], trigger [suspected], cardiovascular/neurological state [trend], initial support [given] and endocrine/critical-care plan [status].