{"title":"Thyroid Emergencies: A Narrative Review.","authors":"Margaret L Kruithoff, Benjamin J Gigliotti","doi":"10.1016/j.eprac.2025.06.010","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Myxedema coma and thyroid storm are rare thyroid emergencies associated with considerable mortality and morbidity.</p><p><strong>Results: </strong>Myxedema coma is a state of decompensated hypothyroidism with widespread multi-organ dysfunction, including impaired consciousness, mixed respiratory failure, and hypothermia. Thyroid storm is the extreme state of thyrotoxicosis occurring when a patient's metabolic, thermoregulatory, and cardiovascular compensatory mechanisms are surpassed; clinical features include hyperthermia, neuropsychiatric symptoms, and tachyarrhythmias. Thyroid emergencies usually result from a precipitating event or trigger transforming a previously compensated hypothyroid or thyrotoxic state. Supportive care for the cardiovascular, respiratory, and thermoregulatory manifestations, as well as possible intercurrent illness or adrenal insufficiency, plays a lead role in the management. For myxedema coma, treatment typically includes high-dose levothyroxine with the addition of liothyronine for critically ill patients. Management of thyroid storm is multipronged and stepwise, consisting of first-line thionamide and beta-adrenergic receptor antagonist therapy, followed by inorganic iodine, cholestyramine, plasmapheresis, or emergent thyroidectomy in appropriate severely ill patients.</p><p><strong>Conclusions: </strong>This review provides an updated narrative overview of the diagnosis and management of myxedema coma and thyroid storm.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Endocrine Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.eprac.2025.06.010","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Myxedema coma and thyroid storm are rare thyroid emergencies associated with considerable mortality and morbidity.
Results: Myxedema coma is a state of decompensated hypothyroidism with widespread multi-organ dysfunction, including impaired consciousness, mixed respiratory failure, and hypothermia. Thyroid storm is the extreme state of thyrotoxicosis occurring when a patient's metabolic, thermoregulatory, and cardiovascular compensatory mechanisms are surpassed; clinical features include hyperthermia, neuropsychiatric symptoms, and tachyarrhythmias. Thyroid emergencies usually result from a precipitating event or trigger transforming a previously compensated hypothyroid or thyrotoxic state. Supportive care for the cardiovascular, respiratory, and thermoregulatory manifestations, as well as possible intercurrent illness or adrenal insufficiency, plays a lead role in the management. For myxedema coma, treatment typically includes high-dose levothyroxine with the addition of liothyronine for critically ill patients. Management of thyroid storm is multipronged and stepwise, consisting of first-line thionamide and beta-adrenergic receptor antagonist therapy, followed by inorganic iodine, cholestyramine, plasmapheresis, or emergent thyroidectomy in appropriate severely ill patients.
Conclusions: This review provides an updated narrative overview of the diagnosis and management of myxedema coma and thyroid storm.
期刊介绍:
Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.