Hepatic Failure/GI/Endocrine Emergencies
Hyperthermia and diaphoresis are cardinal manifestations of thyroid crisis. Other key
components include tachycardia out of proportion to fever and gastrointestinal dysfunction
(nausea, vomiting, diarrhea, jaundice).
ii.
In progressive thyroid crisis, patients may develop mental status changes (e.g., agitation,
psychosis, coma), and altered mentation has been associated with higher mortality. Other
clinical manifestations include cardiac arrhythmias, heart failure, and tachypnea.
iii.
Serum TSH is often below the normal range with elevated free T3 and free and total T4. Total
T3 levels may be within normal limits in patients with a precipitating illness that reduces T4 to
T3 conversion.
iv.
Other laboratory abnormalities include hypercalcemia, hyperglycemia, leukocytosis or
leukopenia, and elevated liver function tests.
No universally accepted diagnostic criteria exist, but the Burch and Wartofsky criteria (Table
7) can be used to identify potential thyroid storm. Although this scoring system is effective, it
is not highly specific.
Criteria
Points
Temperature (Β°F)
β’ 99β99.9
β’ 100β100.9
β’ 101β101.9
β’ 102β102.9
β’ 103β103.9
β’ β₯ 104
Heart rate (beats/minute)
β’ 99β109
β’ 110β119
β’ 120β129
β’ 130β139
β’ β₯ 140
Atrial fibrillation
β’ Absent
β’ Present
Congestive heart failure
β’ Absent
β’ Mild (edema)
β’ Moderate (rales)
β’ Severe (pulmonary edema)
GI signs
β’ Absent
β’ Moderate (nausea, vomiting, diarrhea, abdominal pain)
β’ Severe (jaundice)
CNS disturbance
β’ Absent
β’ Mild (agitation)
β’ Moderate (delirium, psychosis, extreme lethargy)
β’ Severe (seizure, coma)