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Copyright (c) 2026 Ahmed Ali M. Abu Shaeqa, Ali Ahmed Ali Bahri, Omar Mohammed Ali Zain Aldin, Hassan Ibrahim Abdullah AlNahari, Ahmad Al Rithi Dagasi, Hawi Mohammed Ahmed Jafari, Jaber Yahya Mousa Shaybah, Saud Asal Khalaf Alenezi, Mousa Mohammed Aqeel Abu Shaeqah
This work is licensed under a Creative Commons Attribution 4.0 International License.
Management of Thyroid Emergencies: Clinical Assessment, Diagnosis, and Evidence-Based Treatment Protocols-An Updated Review
Corresponding Author(s) : Ahmed Ali M. Abu Shaeqa
Saudi Journal of Medicine and Public Health, Vol. 3 No. 1 (2026)
Abstract
Background: Thyroid storm is a rare, life-threatening endocrine emergency characterized by severe thyrotoxicosis accompanied by multiorgan dysfunction. Despite advances in diagnosis and treatment, it remains associated with substantial mortality, particularly when recognition and intervention are delayed.
Aim: This review aims to summarize the clinical presentation, diagnostic approaches, precipitating factors, and evidence-based management strategies for thyroid storm, emphasizing early recognition and prevention of complications.
Methods: A narrative review of clinical and scientific literature was conducted to examine epidemiology, pathophysiology, diagnostic criteria, supportive measures, pharmacological interventions, and advanced treatment options for thyroid storm. Attention was given to the Burch–Wartofsky Point Scale (BWPS), Japanese Thyroid Association/Japan Endocrine Society criteria, and contemporary intensive care management.
Results: Thyroid storm is most associated with Graves’ disease and may be precipitated by infection, surgery, trauma, cardiovascular events, parturition, diabetic ketoacidosis, or iodine exposure. Diagnosis remains primarily clinical because thyroid hormone concentrations alone cannot reliably distinguish thyroid storm from uncomplicated thyrotoxicosis. The BWPS and Japanese criteria provide complementary diagnostic frameworks, although both have limitations. Management requires urgent multidisciplinary care, including supportive treatment, beta-adrenergic blockades, antithyroid medications, inorganic iodine, and glucocorticoids. Refractory cases may require adjunctive therapies, therapeutic plasma exchange, emergency thyroidectomy, or extracorporeal circulatory support.
Conclusion: Early diagnosis, prompt multimodal treatment, and appropriate intensive care are essential to improve outcomes and reduce mortality in thyroid storm.
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- Galindo RJ, Hurtado CR, Pasquel FJ, et al. National trends in incidence, mortality, and clinical outcomes of patients hospitalized for thyrotoxicosis with and without thyroid storm in the United States, 2004–2013. Thyroid 2019 29 36–43. https://doi.org/10.1089/thy.2018.0275
- Akamizu T, Satoh T, Isozaki O, et al. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. Thyroid 2012 22 661–679. https://doi.org/10.1089/thy.2011.0334
- Angell TE, Lechner MG, Nguyen CT, et al. Clinical features and hospital outcomes in thyroid storm: a retrospective cohort study. J Clin Endocrinol Metab 2015 100 451–459. https://doi.org/10.1210/jc.2014-2850
- Wiersinga WM, Poppe KG & Effraimidis G. Hyperthyroidism: aetiology, pathogenesis, diagnosis, management, complications, and prognosis. Lancet Diabetes Endocrinol 2023 11 282–298. https://doi.org/10.1016/s2213-8587(23)00005-0
- Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016 26 1343–1421. https://doi.org/10.1089/thy.2016.0229
- Burch HB & Wartofsky L. Life-threatening thyrotoxicosis: thyroid storm. Endocrinol Metab Clin N Am 1993 22 263–277. https://doi.org/10.1016/s0889-8529(18)30165-8
- Bourcier S, Coutrot M, Kimmoun A, et al. Thyroid storm in the ICU: a retrospective multicenter study. Crit Care Med 2020 48 83–90. https://doi.org/10.1097/ccm.0000000000004078
- Satoh T, Isozaki O, Suzuki A, et al. 2016 guidelines for the management of thyroid storm from the Japan Thyroid Association and Japan Endocrine Society (first edition). Endocr J 2016 63 1025–1064. https://doi.org/10.1507/endocrj.ej16-0336
- Furukawa Y, Tanaka K, Isozaki O, et al. Prospective multicenter registry-based study on thyroid storm: the guidelines for management from Japan are useful. J Clin Endocrinol Metab 2024 110 e87–e96. https://doi.org/10.1210/clinem/dgae124
- Kopp PA, Giordani I, Feldt-Rasmussen U, et al. Approach to the patient with thyroid storm. J Clin Endocrinol Metab 2026 111 1484–1494. https://doi.org/10.1210/clinem/dgag054
- Kahaly GJ, Bartalena L, Hegedus L, et al. 2018 European Thyroid Association Guideline for the management of Graves’ hyperthyroidism. Eur Thyroid J 2018 7 167–186. https://doi.org/10.1159/000490384
- Kostopoulos G & Effraimidis G. Approach to the patient with severe hyperthyroidism-related complications. J Clin Endocrinol Metab 2026 111 1751–1764. https://doi.org/10.1210/clinem/dgag112
- Lee SY, Modzelewski KL, Law AC, et al. Comparison of propylthiouracil vs methimazole for thyroid storm in critically ill patients. JAMA Netw Open 2023 6 e238655. https://doi.org/10.1001/jamanetworkopen.2023.8655
- Milan SA, Wu LS & Sosa JA. Thyroidectomy under local anesthesia. Curr Surg Rep 2013 2 37. https://doi.org/10.1007/s40137-013-0037-7
- Eltahir M, Chaudhry H, Ibrahim EA, et al. Thyroid storm-induced refractory multiorgan failure managed by veno-arterial extracorporeal membrane oxygenation support: a case-series. Am J Case Rep 2023 24 e940672. https://doi.org/10.12659/ajcr.940672
References
Galindo RJ, Hurtado CR, Pasquel FJ, et al. National trends in incidence, mortality, and clinical outcomes of patients hospitalized for thyrotoxicosis with and without thyroid storm in the United States, 2004–2013. Thyroid 2019 29 36–43. https://doi.org/10.1089/thy.2018.0275
Akamizu T, Satoh T, Isozaki O, et al. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. Thyroid 2012 22 661–679. https://doi.org/10.1089/thy.2011.0334
Angell TE, Lechner MG, Nguyen CT, et al. Clinical features and hospital outcomes in thyroid storm: a retrospective cohort study. J Clin Endocrinol Metab 2015 100 451–459. https://doi.org/10.1210/jc.2014-2850
Wiersinga WM, Poppe KG & Effraimidis G. Hyperthyroidism: aetiology, pathogenesis, diagnosis, management, complications, and prognosis. Lancet Diabetes Endocrinol 2023 11 282–298. https://doi.org/10.1016/s2213-8587(23)00005-0
Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016 26 1343–1421. https://doi.org/10.1089/thy.2016.0229
Burch HB & Wartofsky L. Life-threatening thyrotoxicosis: thyroid storm. Endocrinol Metab Clin N Am 1993 22 263–277. https://doi.org/10.1016/s0889-8529(18)30165-8
Bourcier S, Coutrot M, Kimmoun A, et al. Thyroid storm in the ICU: a retrospective multicenter study. Crit Care Med 2020 48 83–90. https://doi.org/10.1097/ccm.0000000000004078
Satoh T, Isozaki O, Suzuki A, et al. 2016 guidelines for the management of thyroid storm from the Japan Thyroid Association and Japan Endocrine Society (first edition). Endocr J 2016 63 1025–1064. https://doi.org/10.1507/endocrj.ej16-0336
Furukawa Y, Tanaka K, Isozaki O, et al. Prospective multicenter registry-based study on thyroid storm: the guidelines for management from Japan are useful. J Clin Endocrinol Metab 2024 110 e87–e96. https://doi.org/10.1210/clinem/dgae124
Kopp PA, Giordani I, Feldt-Rasmussen U, et al. Approach to the patient with thyroid storm. J Clin Endocrinol Metab 2026 111 1484–1494. https://doi.org/10.1210/clinem/dgag054
Kahaly GJ, Bartalena L, Hegedus L, et al. 2018 European Thyroid Association Guideline for the management of Graves’ hyperthyroidism. Eur Thyroid J 2018 7 167–186. https://doi.org/10.1159/000490384
Kostopoulos G & Effraimidis G. Approach to the patient with severe hyperthyroidism-related complications. J Clin Endocrinol Metab 2026 111 1751–1764. https://doi.org/10.1210/clinem/dgag112
Lee SY, Modzelewski KL, Law AC, et al. Comparison of propylthiouracil vs methimazole for thyroid storm in critically ill patients. JAMA Netw Open 2023 6 e238655. https://doi.org/10.1001/jamanetworkopen.2023.8655
Milan SA, Wu LS & Sosa JA. Thyroidectomy under local anesthesia. Curr Surg Rep 2013 2 37. https://doi.org/10.1007/s40137-013-0037-7
Eltahir M, Chaudhry H, Ibrahim EA, et al. Thyroid storm-induced refractory multiorgan failure managed by veno-arterial extracorporeal membrane oxygenation support: a case-series. Am J Case Rep 2023 24 e940672. https://doi.org/10.12659/ajcr.940672