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 (°F)

• 99–99.9

• 100–100.9

• 101–101.9

• 102–102.9

• 103–103.9

• ≥ 104

Heart rate (beats/minute)

• 99–109

• 110–119

• 120–129

• 130–139

• ≥ 140

Atrial fibrillation

• Absent

• Present

Congestive heart failure

• Absent

• Mild (edema)

• Moderate (rales)

• Severe (pulmonary edema)

GI signs

• Absent

• Moderate (nausea, vomiting, diarrhea, abdominal pain)

• Severe (jaundice)

CNS disturbance

• Absent

• Mild (agitation)

• Moderate (delirium, psychosis, extreme lethargy)

• Severe (seizure, coma)