Thyroid Disease Hyperthyroidism An Overview of Thyroid Storm This life-threatening condition requires immediate medical attention By Mary Shomon facebook twitter linkedin Mary Shomon is a writer and hormonal health and thyroid advocate. She is the author of "The Thyroid Diet Revolution." Learn about our editorial process Mary Shomon Medically reviewed by Medically reviewed by Ana Maria Kausel, MD on January 05, 2020 facebook twitter Ana Maria Kausel, MD, is a double board-certified endocrinologist affiliated with Mount Sinai St. Luke's/Mount Sinai West in New York City. Learn about our Medical Review Board Ana Maria Kausel, MD on January 05, 2020 Print Table of Contents View All Causes and Risk Factors Symptoms Diagnosis Treatment Graves' disease is an autoimmune disease that typically causes hyperthyroidism, in which the thyroid gland produces too much thyroid hormone and becomes overactive. In 1 percent to 2 percent of cases, the thyroid produces an extreme amount of the key hormones involved in thyroid function—triiodothyronine (T3) and thyroxine (T4). This can cause your heart rate, blood pressure, and body temperature to become uncontrollably high—what's known as a thyroid storm. This is dangerous and potentially life-threatening. Verywell / Laura Porter Causes and Risk Factors The primary risk factor for thyroid storm is having untreated Graves' disease and/or hyperthyroidism. Even when the Graves' disease is identified and being treated, there are a number of other factors that raise your risk of thyroid storm: Infection, specifically lung infections, throat infections, or pneumoniaBlood sugar changes, including diabetic ketoacidosis and insulin-induced hypoglycemiaRecent surgery on your thyroid gland or trauma to your thyroidAbrupt withdrawal of your antithyroid medicationsRadioactive iodine (RAI) treatment of your thyroidExcessive palpation (handling/manipulation) of your thyroid glandExposure to a large quantity of iodine (such as an iodine-based contrast agent or the heart drug amiodarone)Severe emotional stressAn overdose of thyroid hormone drugsToxemia of pregnancy and labor What Is Causing Your Hyperthyroidism? Symptoms Symptoms of thyroid storm are usually quite extreme and include: A very high fever of 100 to 106 degreesA very high heart rate, which can be as high as 200 beats per minute (BPM) Palpitations, chest pain, and shortness of breathHigh blood pressureConfusion, delirium, and even psychosisExtreme physical and muscle weaknessExtreme fatigue and exhaustionExtreme restlessness, nervousness, and mood swingsExaggerated reflexes, especially in knee and ankle areasDifficulty breathingNausea, vomiting, and diarrheaProfuse sweating or dehydrationStupor or comaRecent dramatic weight loss Complications of thyroid storm include stroke and heart attack, which can lead to death. When to Go to the ER Whenever thyroid storm is suspected, you must go to the emergency room immediately. Thyroid storm requires immediate treatment, as it is life-threatening and can develop and worsen quickly. Diagnosis Physicians have developed a scoring system that helps them quickly assess symptoms and make a presumptive diagnosis of thyroid storm, so they can rapidly begin treatment. The system involves measuring temperature, heart rate, gastrointestinal symptoms, neurological symptoms, and noting whether the patient has had a previous thyroid storm. Sometimes, blood tests are done to look for high levels of thyroid hormones; a TSH (thyroid stimulating hormone) test may also be done. Because thyroid storm is a medical emergency, however, there is rarely time to wait for test results and treatment is started immediately. Treatment When treating thyroid storm, doctors often use the "five Bs": Block the synthesis of thyroid hormone using antithyroid drugs: This is typically done right away with larger initial loading doses and frequent administration of additional doses. In patients who can't tolerate antithyroid drugs, lithium is sometimes used.Block the release of thyroid hormone using a potassium iodide preparation: This is usually given after the antithyroid drugs and helps suppress thyroid hormone release. Block T4 to T3 conversion using a corticosteroid drug, such as hydrocortisone Use of a beta-blocker drug, such as propranolol, to reduce blood pressure and heart rateReduce the reabsorption of thyroid hormones with a bile acid sequestrate such as cholestyramine Supportive treatment may also include cooling to help reduce body temperature, fluids to combat dehydration, and treatment of any other infections. Typically, if the treatments are going to work, the improvement will be seen within 24 to 72 hours. The mortality rate in people whose thyroid storm goes untreated is as high as 75 percent. When treated, mortality goes down to 20 percent to 30 percent. When thyroid storm does not respond to these approaches, plasmapheresis, a blood filtering treatment, is sometimes done to remove thyroid hormone from the bloodstream. Only a small percentage of the hormone can be removed during each session, so it needs to be performed several times. In rare cases, the thyroid is surgically removed, but physicians have to be particularly careful, as the surgery can precipitate a worsening of thyroid storm if hormone levels are already high. All About How to Take Your Thyroid Medication A Word From Verywell While thyroid storm is rare, it is life-threatening. Always stay up to date on annual physical exams; your doctor will palpate your thyroid to check if it's enlarged (a sign of hyperthyroidism) and test levels of thyroid hormones in your blood as part of a routine check-up. If you have been diagnosed with Graves' disease or hyperthyroidism, always take your medication and have your thyroid levels tested regularly according to your doctor's instructions. Was this page helpful? Thanks for your feedback! Losing weight with thyroid disease can be a struggle. Our thyroid-friendly meal plan can help. Sign up and get yours free! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Karger S, Führer D. Thyroid storm--thyrotoxic crisis: an update. Dtsch Med Wochenschr. 2008;133(10):479-84. doi:10.1055/s-2008-1046737 Carroll R, Matfin G. Endocrine and metabolic emergencies: thyroid storm. Ther Adv Endocrinol Metab. 2010;1(3):139–145. doi:10.1177/2042018810382481