Thyroid storm: Diagnostic criteria and red flags

Dr Leonard Wartofsky is a professor of medicine at Georgetown University Hospital, chairman emeritus of the Department of Medicine at the Washington Hospital Center, and past president of the American Thyroid Association and the Endocrine Society.

What are the key diagnostic criteria for thyroid storm? What signs and symptoms are the most alarming and require immediate medical attention?

Leonard Wartofsky, MD, MPH: The key findings that lead one to tip the scale and make the diagnosis of thyroid storm are the temperature; fever, if present; extent of tachycardia; rhythm disturbances such as atrial fibrillation; and congestive heart failure.

Very ominous signs are jaundice and gastrointestinal (GI) dysfunction with rapidly rising liver function test abnormality. Those would be critical findings that would clearly suggest you’ve moved from garden-variety thyrotoxicosis into storm. Even worse would be any mental aberrations: hallucinations, confusion, and of course coma.