think "functional metastatic thyroid cancer". 1993 Jun. Endocrinol Metab Clin North Am. Thyroid storm is a clinical manifestation of an extreme hyperthyroid state that results in significant morbidity or disability or even death. 2016 Aug 27. You may be given calcium and vitamin D supplements, and hormone replacement therapy is needed in some cases. If the nerve was injured, more severe symptoms may be noted after surgery. Pazaitou-Panayiotou K, Michalakis K, Paschke R. Thyroid cancer in patients with hyperthyroidism. Surgery. 1993 Jun;22(2):263-77 2010 Jul-Aug;16(4):673-6. doi: 10.4158/EP09265.CR. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. [1], ATA guidelines also recommend that patients undergoing thyroidectomy be rendered euthyroid with methimazole preoperatively and that potassium iodide (KI) be given in the immediate preoperative period. thyroid storm with propylthiouracil, hydrocortisone, potassium iodide and propranolol. A drop in binding protein levels, which may occur postoperatively, might cause a sudden rise in free hormone levels. 2011 Dec. 15(6):522-31. Cleveland Clinics Endocrinology & Metabolism Institute is committed to providing the highest quality healthcare for patients with diabetes, endocrine and metabolic disorders, and obesity. Some causes of rapidly increased thyroid hormone levels include the following: Other common precipitants include the following: Although it can develop in toxic adenoma or multinodular toxic goiter, thyroid storm is more commonly seen in toxicity secondary toGraves disease. Keep in mind that even when complications occur, which is not common, prompt treatment is often successful to restore your health. [Thyroid storm associated with multiorganic dysfunction]. [QxMD MEDLINE Link]. [15]. Diagnosis is primarily clinical, and no specific laboratory tests are available. As the patient improves, reduce digoxin dose. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. A 2018 study found that when a solution of potassium iodide was given prior to thyroid surgery for those with Grave's diseasea condition that can lead to an overactive thyroidit was associated with less temporary hypoparathyroidism and hoarseness. Surgical management of an atypical presentation of a thyroid storm. [QxMD MEDLINE Link]. Thyroid. The researches theorized that the decreased mortality rates were due to improved intensive care and increasing use of mechanical circulatory devices such as the intra-aortic balloon pump (IABP) and extra corporeal mechanical ventilation (ECMO). The thyroid gland produces and releases two main hormones: the 'active' triiodothyronine (T3) and the 'inactive' thyroxine (T4). Thyroid storm can lead to serious complications if treatment is delayed or if its untreated, including: If youre experiencing symptoms of thyroid storm such as a high fever and a rapid heart rate, get to the nearest emergency room as soon as possible. This is because post-surgical consequences often include a sore throat and such foods might enhance the level of discomfort. When theres intense metabolic activity, your body needs more oxygen. Braverman, MD, Lewis E., and Robert D. Utiger, MD. In a series of 24 patients with iodine-induced hyperthyroidism who underwent surgical thyroidectomy after medical therapy failed, all but one patient survived. Using an over-the-counter (OTC) numbing throat spray, such as Chloraseptic, or numbing lozenges, such as Cepacol, can help with the discomfort until you are healed. However, with treatment, most people experience improvement within 24 hours. Since it's common for the parathyroid glands to function poorly after a thyroidectomy, you may be sent home with calcium and vitamin D supplements. What Is the Recovery Time for Appendicitis Surgery? She also had acute heart failure, atrial fibrillation and hepatic failure. Thyroid storm. 2012 Jul. The boxed warning also states that propylthiouracil should be reserved for use in those who cannot tolerate other treatments such as methimazole, radioactive iodine, or surgery. [14]. Many surgeons recommend doing gentle stretching and range-of-motion exercises to reduce stiffness. Epub 2015 Jun 22. Laryngoscope. It produces dramatic improvement in clinical status and greatly ameliorates symptoms. [Full Text]. Thyroid. Thyroid storm is the most severe form of hyperthyroidism, wherein organ failure begins to occur. Keep in mind, as well, that the likelihood of a complication occurring is much less with an experienced surgeon. 2018 Jan. 28(1):32-40. 2020 June 20. Recommended exercises may include: Suggested frequency: 10 repetitions, three times day. We herein describe the case of a 37-year-old patient with a history of Graves' disease who was transferred to Tottori University Hospital with thyroid storm. Thyroidectomy should be considered for anyone with Graves' disease (GD) and moderate-to-severe eye disease, or smokers with GD due to increased risk of exacerbation of eye disease after radioactive iodine. For suspected liver injury, promptly discontinue PTU therapy and evaluate for evidence of liver injury and provide supportive care. [1], According to the guidelines of the American Thyroid Association (ATA), a multimodality treatment approach should be individualized to the patient and includes -adrenergic blockade, ATD therapy, inorganic iodide, corticosteroid therapy, cooling with acetaminophen and cooling blankets, volume resuscitation, nutritional support, respiratory care, and monitoring in an intensive care unit. The https:// ensures that you are connecting to the It is uncommon, but when it occurs after thyroidectomy, it is usually associated with Grave's disease. Factors associated with mortality of thyroid storm: analysis using a national inpatient database in Japan. Angell TE, Lechner MG, Nguyen CT, Salvato VL, Nicoloff JT, LoPresti JS. . Heart rate faster than 140 beats/min, hypotension, atrial dysrhythmias, congestive heart failure, 3. It's also important to talk about how to properly take your medication, as food and many drugs and supplements can interfere with absorption. She was discharged the following day. Based on a work at https://medcraveonline.com Contact Us, 2014-2023 MedCrave Group. Because thyroid hormones affect many of your bodys functions, signs and symptoms of Graves disease can be wide ranging. Pokhrel B, Aiman W, Bhusal K. Thyroid Storm. It may also improve the safety of the procedure for those with Graves disease. Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. 2014 Apr. You should not submerge, soak, or scrub your incision, and bathing in a tub should be avoided until you see your surgeon. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2020 Jun 12;56(6):290. doi: 10.3390/medicina56060290. Dont wait for your symptoms to get worse. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Thyroid Hormone Reference Range May Not Apply for Cancer Patients, FDA OKs Pembrolizumab for Adjuvant Treatment of NSCLC, Recognizing the Signs: Heart Failure and Type 2 Diabetes, Myopathies: Muscling Your Way to the Diagnosis. Luckily, its rare and treatable. Together, they are referred to as thyroid hormones, and they regulate your body temperature and control your heart rate and metabolism. 10th ed.,Philadelphia: Lippincott Williams & Wilkins (LWW), 2012. The treatment strategy for thyroid storm can be divided into four general categories, including: Medications and treatment therapies for thyroid storm can include: If you have thyroid storm, youll likely be in the intensive care unit (ICU) of the hospital so your healthcare team can monitor your symptoms and condition frequently. Akamizu T. Thyroid storm: a Japanese perspective. MeSH Gunateet Goswami, MD is a member of the following medical societies: American Medical Association, American Society of Echocardiography, Michigan State Medical SocietyDisclosure: Nothing to disclose. KI is recommended to reduce thyroid gland vascularity with the goal of improving operative visualization and reducing operative complications. Isabel Casimiro, MD, is board-certified in internal medicine and works as an endocrinologist at the University of Chicago. Tower 1, Capital Square, Vci t 76. 2015 Feb. 21(2):182-9. which Acetaminophen and cooling blankets to lower your temperature. When only part of it is removed, it may continue to function as normal without medication but it may not. Only a few studies have tried to report the risks of hypoparathyroidism. For patient education resources, see theThyroid and Metabolism Center as well as Thyroid Problems,Thyroid Storm, and Graves Disease. World J Surg. Approach Considerations Goals of treatment are lowering of thyroid hormone synthesis and secretion, reduction of circulating thyroid hormones, control of the peripheral effects of thyroid. She later received external beam radiation therapy for brain metastases. StatPearls [Internet]. [Full Text]. eCollection 2022 May. 2009 Feb. 102(2):193-5. Dean Toriumi, MD Associate Professor, Department of Otolaryngology, University of Illinois Medical CenterDisclosure: Nothing to disclose. Gunateet Goswami, MD Consulting Staff, Internal Medicine Associates, Mount Clemens, Michigan; Consulting Staff, Department of Cardiology, Henry Ford Hospital Fewer than 100 cases of hyperthyroidism due to functional thyroid metastases can be found in the literature and fewer than 20 of these cases are due to papillary carcinoma. 1999 Dec;29(4):318-21 It accounts for 2% to 15% of all thyroid cancers. 63(12):1025-64. PTU also blocks peripheral conversion of T4 to T3 and hence is preferred in thyroid storm over MMI. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Due to the rarity of this condition and its multitude of diverse presentations, diagnosis can be extremely challenging. 2017;6(1):20-25. doi:10.1159/000450976, Padur AA, Kumar N, Guru A, et al. About ten days prior to her admission at our hospital, she consulted her family doctor with complaints of dyspnea, palpitations and general fatigue. 8600 Rockville Pike Thyroid storm is a fulminating crisis that demands an intensive level of care, continuous monitoring, and vigilance. [QxMD MEDLINE Link]. 2019 Apr. [QxMD MEDLINE Link]. Zhong HJ, Yang TD. Endocr Pract. If you are wondering what your scar may look like, the University of California Los Angeles has a scar gallery with photos of people who have had thyroid surgery at various points in the healing process. The decision was made to proceed with thyroidectomy. Successful treatment of thyroid storm with plasmapheresis in a patient with methimazole-induced agranulocytosis. Confusion, agitation, delirium, frank psychosis, seizures, stupor, or coma. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvODUwOTI0LW92ZXJ2aWV3. Background Thyroid storm, also referred to as thyrotoxic crisis, is an acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones (THs) in individuals with. Nafisa K Kuwajerwala, MD is a member of the following medical societies: American College of Surgeons, American Society of Breast Surgeons, American Society of Breast DiseaseDisclosure: Nothing to disclose. Adrenergic receptor activation is another hypothesis. The neck is put in an extended position during surgery, and many people avoid moving their necks afterward. Barwinek K, Gsior-Perczak D, Trepka S, Szczodry A, Kopczyski J, Sitarz-elazna Z, Kowalska A. Medicina (Kaunas). Other proposed theories include alterations in tissue tolerance to THs, the presence of a unique catecholaminelike substance in thyrotoxicosis, and a direct sympathomimetic effect of TH as a result of its structural similarity to catecholamines. Depending on the surgeon, you may have stitches that will need to be removed or absorbable sutures that will not. WHO SHOULD CONSIDER THYROIDECTOMY FOR MANAGEMENT OF GRAVES' DISEASE? 2014;38(10):2613-20. doi:10.1007/s00268-014-2622-z, Qiao N, Wu LF, Gao W, et al. If in remission, the patient should be closely monitored for 6 months, as relapse is more common during this period after discontinuation of therapy. Symptoms include weight loss, palpitations, and weakness but patients don't have ophthalmopathy. Last reviewed by a Cleveland Clinic medical professional on 06/08/2022. [Full Text]. [Full Text]. If you have a subtotal thyroidectomy, which means all but a small portion of your thyroid is removed to try to preserve thyroid function, hypothyroidism sometimes still occurs and you will need monitoring to see if replacement therapy is needed. Endocr Pract. . 2003 Oct;13(10):933-40 Your thyroid is a butterfly-shaped gland located in the front of your neck. Eur Thyroid J. [QxMD MEDLINE Link]. Congestive cardiac failure is seen as a result of impaired myocardial contractility and may require Swan-Ganz catheter monitoring. A 74-year-old female with a history of left hemithyroidectomy over 50 years ago for thyroid nodules that were reportedly benign presented to the hospital with right lower extremity pain. 2012 Sep. 109(3):466-7. Angell TE, Lechner MG, Nguyen CT, Salvato VL, Nicoloff JT, LoPresti JS. 2016 Oct. 26(10):1343-1421. If left untreated, this may lead to multi-organ failure and death. Approximately 10% to 30% of thyroid storm cases result in death. Researchers arent yet sure why certain factors can result in thyroid storms. No part of this content may be reproduced or transmitted in any form or by any means as per the standard guidelines of fair use permits unrestricted use, distribution, and build upon your work non-commercially. Thyroid storm is a serious and life-threatening medical condition. Galindo RJ, Hurtado CR, Pasquel FJ, Garcia Tome R, Peng L, Umpierrez GE. Spicy Food. Anticoagulation drugs may be needed for atrial fibrillation and can be administered in the absence of contraindications. Trends in the incidence and in-hospital outcomes of cardiogenic shock complicating thyroid storm. Get useful, helpful and relevant health + wellness information. 2016 Dec 30. This website also contains material copyrighted by 3rd parties. These glands are responsible for controlling the body's calcium levels. However, there are some things that everyone can expect with any type of thyroid surgery. Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine Successful treatment with reserpine in cases of thyroid storm resistant to large doses of propranolol has been documented. The risk of infection is present with any type of surgery but is relatively rare with thyroid surgery. Effect on functioning metastases of adenocarcinoma of the thyroid. [QxMD MEDLINE Link]. If you experience itching, applying scar gel or aloe may provide relief, but talk to your surgeon before doing so. [Full Text]. Pressor agents can be used when hypotension persists following adequate fluid replacement. Using pain medication after surgery may reduce discomfort, making it easier for you to keep moving your neck so that you have less stiffness later on. Having neurological issues upon admission to a hospital, such as decreased sensation and mental function issues. Prediction of permanent hypoparathyroidism after total thyroidectomy. Accessed 6/8/2022. https://www.ncbi.nlm.nih.gov/books/NBK448095/. You may also wish to ask about their complication rate, but this is not necessarily an accurate measure of competence. 4 Thyroid storm is . Symptoms may include an area of firmness and swelling on the front or side of the neck (usually beneath the incision), neck pain, and symptoms of airway obstruction such as shortness of breath, lightheadedness, or stridor (a high-pitched wheezing sound that's usually most noticeable with inspiration than exhalation). Patients unable to take PTU or MMI also can be treated with lithium, as use of iodine alone is debatable. Presently, these techniques are reserved for patients who do not respond to the initial line of management. Gunateet Goswami, MD Consulting Staff, Internal Medicine Associates, Mount Clemens, Michigan; Consulting Staff, Department of Cardiology, Henry Ford Hospital Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. 2016 May;46(5):575-82. doi: 10.1007/s00595-015-1209-0. What You Need to Know Thyroid cancer, thyroid nodules and other conditions may require thyroidectomy. A nomogram to predict the likelihood of permanent hypoparathyroidism after total thyroidectomy based on delayed serum calcium and iPTH measurements. While temporary in some cases, hypoparathyroidism caused by the injury or removal of parathyroid glands can be permanent. Though thyroid surgery is considered a relatively safe procedure, complications may sometimes occur. If any of these symptoms occur, immediate evaluation by a healthcare provider or an ear, nose, and throat (ENT) doctor is recommended. Am J Med Sci. The majority of patients with PDTC die of metastatic disease. Use of glucocorticoids in thyroid storm is associated with improved survival rates. Anatomic characteristics, identification, and protection of the nonrecurrent laryngeal nerve during thyroidectomy. [4, 7], Age and sex predilection depends on the etiology of thyrotoxicity. Ther Apher Dial. [QxMD MEDLINE Link]. ", Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Dare to Compare: Do You Know the Latest on Immuno-Oncology in Advanced Non-Small Cell Lung Cancer? Like you dont have control of your body. Hii B, Maher D, Yeung M, Paul E, Serpell JW, Lee JC. A history of hepatotoxicity or agranulocytosis from previous thioamide therapy precludes use of PTU and MMI. Thabet Abbarah, MD, FACS Consulting Staff, Department of Otolaryngology, North Oakland Medical Centers [QxMD MEDLINE Link]. The US Food and Drug Administration (FDA) had added a boxed warning, the strongest warning issued by the FDA, to the prescribing information for propylthiouracil. Failure of esmolol to control tachycardia associated with thyroid storm after subtotal thyroidectomy. THYROID. Thyroidectomy then and now: a 50-year Australian perspective. Thyroid storm is a rare and life-threatening condition that can affect people with hyperthyroidism. With this in mind, it's a good idea to ask your surgeon how many thyroidectomies they have performed in the past. If you log out, you will be required to enter your username and password the next time you visit. Aulet RM, Wein RO, Siegel RD. Thyroid storm is a life-threatening condition that is generally considered to be a contradiction to surgical intervention. 12(2):e13539. Akamizu T, Satoh T, Isozaki O, et al, for the Japan Thyroid Association. Having regular thyroid testing done is also important, as hypothyroidism may not occur right away, or even for months or years. National trends in incidence, mortality, and clinical outcomes of patients hospitalized for thyrotoxicosis with and without thyroid storm in the United States, 2004-2013. These reports suggest an increased risk for liver toxicity with PTU compared with methimazole. If you have hyperthyroidism and are having thyroid surgery (thyroidectomy), your provider will most likely give you certain medication before the surgery to try to prevent thyroid storm. Br J Anaesth. [QxMD MEDLINE Link]. Nausea and vomiting after thyroidectomy was the norm at one time, and people may be concerned if they talk with others who had this procedure in the past. Cooling blankets, ice packs, and alcohol sponges encourage dissipation of heat. Multivitamins, especially vitamin B-1, are added to prevent Wernicke encephalopathy. Muller C, Perrin P, Faller B, Richter S, Chantrel F. Role of plasma exchange in the thyroid storm. [QxMD MEDLINE Link]. Nafisa K Kuwajerwala, MD Staff Surgeon, Breast Care Center, William Beaumont Hospital If you are having thyroid surgery, known as a thyroidectomy, to remove all or part of your thyroid glanda butterfly shaped organ at the base of your neckit's important to know what to expect as you recover. Br J Anaesth. 2012 Sep. 109(3):466-7. doi:10.1097/MD.0000000000002812, Almquist M, Hallgrimsson P, Nordenstrm E, Bergenfelz A. Surg Today. Martin D. Disseminated intravascular coagulation precipitated by thyroid storm. Always taking your medication as prescribed by your healthcare provider. 2014 Apr. [Full Text]. Of the adults, 12 deaths and 5 liver transplants occurred, and among the pediatric patients, 1 death and 6 liver transplants occurred. But if severe symptoms occur, intravenous calcium, which is delivered through a vein, in the hospital may be required. South Med J. Transfus Apher Sci. 2013;23(10):1193-202. doi:10.1089/thy.2013.0049. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. Nausea, vomiting, severe diarrhea, abdominal pain, hepatocellular dysfunction-jaundice, 4. [2] Today, thyroid storm occurs more commonly as a medical crisis rather than a surgical crisis. Mohananey D, Smilowitz N, Villablanca PA, et al. This is very common and expected during the first week or two after surgery. Thyroid storm (also called thyroid crisis and thyrotoxic crisis) happens when your thyroid gland releases a large amount of thyroid hormone in a short amount of time. 63(12):1025-64. Would you like email updates of new search results? She has yet to follow up with her outpatient endocrinologist.1-4 . Feeling very agitated and confused. In the days right after surgery, you will need to take care of your incision area (s). Although thyroid storm can develop if you have long-term untreated or undertreated hyperthyroidism, its often caused by a sudden and intense (acute) event or situation. Feeling cold, especially in the extremities, Increased menstrual flow and more frequent periods, The presence of other medical conditions, such as congestive heart failure or a bleeding disorder, Thyroid cancer, especially when a central neck dissection is done to remove lymph nodes. -, J Clin Gastroenterol. Medscape Education. Phone: +36 180 38 002, Email: support@medcrave.com More Locations Thyroid storm If a thyroidectomy is done to treat a very overactive gland, there may be a . Swee du S, Chng CL, Lim A. A diagnosis of thyroid storm was made and she was transferred to our hospital. 2012 Sep. 109(3):466-7. Although medical management with antithyroid medications is the standard of care to re-establish a euthyroid state before more definitive treatment options are undertaken, circumstances may arise that require alternative treatment options. De Leo S, Lee SY, Braverman LE. This theory also explains normal or low plasma levels and urinary excretion rates of catecholamines; however, it does not explain why beta-blockers fail to decrease TH levels in thyrotoxicosis. [QxMD MEDLINE Link]. Confusion, agitation, delirium, frank psychosis, seizures, stupor, or coma. 2011 Dec. 15(6):522-31. Thyroid surgery is often done under general anesthesia with a breathing tube placed in the windpipe, or trachea, to breathe for you. Examples include foods with sauces or gravy, cooked vegetables, and casseroles. Gently tilt your head to the right and then to the left. Thyroid storm after thyroidectomy? [Guideline] Ross DS, Burch HB, Cooper DS, et al. Martin D. Disseminated intravascular . [Full Text]. Patients intolerant to iodine can be treated with lithium, which also impairs thyroid hormone release. Martin D. Disseminated intravascular coagulation precipitated by thyroid storm. Most surgeons recommend leaving these alone until they fall off by themselves, rather than trying to remove them. [Full Text]. It may last for up to six months. Endocrinol Metab Clin North Am. This can lead to neck pain and stiffness. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. Vyas AA, Vyas P, Fillipon NL, Vijayakrishnan R, Trivedi N. Endocr Pract. Fluid requirements may increase to 3-5 L/day. 2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition). excessive release of thyroid hormones (THs), American Association of Endocrine Surgeons, American Association for the Advancement of Science, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Association for Physician Leadership. Int J Surg. This condition is rare and requires immediate medical attention, as it can be life-threatening. Treatment in the intensive care unit includes cooling, intravenous fluids, medications such as propylthiouracil (PTU), and management of arrhythmias. 2017 Aug. 354(2):159-64. Ther Apher Dial. sharing sensitive information, make sure youre on a federal . MOJ Clin Med Case Rep. 2021;11(5):136 DOI: 10.15406/mojcr.2021.11.00399. [17], American Thyroid Association guidelines recommend that patients undergoing thyroidectomy be rendered euthyroid with methimazole preoperatively and that potassium iodide (KI) be given in the immediate preoperative period. Once your thyroid is removed you are now considered to be HYPOTHYROID. Respiratory treatment, such as supplemental oxygen. Lancet. Management of thyroid storm is a multistep process. American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. (See "Nonthyroid surgery in the patient with thyroid disease" and "Surgical management of hyperthyroidism" and "Thyroidectomy" and "Thyroid storm".) Metabolism is the pace at which your body processes things how fast it burns food to make energy and heat. and transmitted securely. The intravenous preparation of sodium iodide (given as 1 g slow infusion q8-12h) has been taken off of the market. Treatment includes immediate surgery to remove the hematoma and address any areas of bleeding. (https://www.ncbi.nlm.nih.gov/books/NBK448095/), Visitation, mask requirements and COVID-19 information. These can include uncontrolled coughing when speaking, difficulty breathing, or the development of aspiration pneumoniawhich is pneumonia caused by substances, such as from the mouth, getting into the lungs. Feeling agitated, irritable and/or anxious. T3 is triiodothyronine. American Thyroid Association statement on outpatient thyroidectomy. Dean Toriumi, MD Associate Professor, Department of Otolaryngology, University of Illinois Medical CenterDisclosure: Nothing to disclose. 2 Thyroid storm in patients with hyperthyroidism is You are being redirected to [5, 8] In one retrospective study from Japan of 1324 patients who were diagnosed with thyroid storm, the following factors were associated with increased mortality risk in thyroid storm Mimi S Kokoska, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Association for Physician Leadership, American College of Surgeons, American Head and Neck SocietyDisclosure: Nothing to disclose.