Endocrine Abstracts (2017) 49 EP1251 | DOI: 10.1530/endoabs.49.EP1251

The challenge of diagnosing thyroid storm: a comparison of the Japanese Thyroid Association Criteria to de Burch Wartofsky Point Scale

María Laura García1, Gabriela Szuman1, María Florencia Scoscia1, Susana Bacigaluppi1, María Victoria Panebianco3 & Noelia Rella1,2

1Sanatorio Méndez, Buenos Aires, Argentina; 2Hospital Británico, Buenos Aires, Argentina; 3CEBBAD, Universidad Maimonides, Buenos Aires, Argentina.

Thyroid storm (TS) is a rare and life threatening condition that requires a prompt recognition and treatment. The clinical features may overlap with other acute medical conditions. Currently both Akamizu Criteria (JTA) and Burch and Wartofsky Scale (BW) are helpful diagnostics tools.

Objective: To evaluate TS patients according to currently available criteria and to identify the clinical features and outcomes.

Methods: A single center retrospective study covering a 6 year period was performed.

Results: Fifteen cases were identified, resulting in four cases of TS per 10 000 admitted. Mean age 49.8±17.3 years (range: 31–86). Male/Female: 3/12. Etiology: autoimmune (n=8), factitious (n=3), amiodarone-induced (n=3), undetermined (n=1). Manifestations at admission: cardiovascular (n=8), fever (n=3), delirium (n=2), diabetic ketoacidosis (n=1) and hypokalemic paralysis (n=1). Eleven had previous history of thyroid disease. Precipitating factors were found in 12 cases. Thyroid hormone levels did not correlate with the severity of thyrotoxicosis. Mortality rate was 6.6%: 1 patient died from sepsis. Late hospital discharge was found in 4 patients (P=0.01): 3 required antithyroid drugs withdrawal and the other received a heart transplant. The table resumes patients according to BW and JTA. JTA fails to detect 4 patients with impending TS (st0), one of which later on developed st1 (p8).

Conclusions: Ours results shows discrepancies between the two diagnostic systems. BW appears to select a higher percentage of patients for aggressive therapy than JTA. This presentation provides useful information for the management of TS, a rare and acute disease that requires high clinical suspicion in order to improve patient survival.


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