Thyroid Storm in the ICU: A Retrospective Multicenter Study

Simon Bourcier, Maxime Coutrot, Antoine Kimmoun, Romain Sonneville, Etienne de Montmollin, Romain Persichini, David Schnell, Julien Charpentier, Cécile Aubron, Elise Morawiec, Naïke Bigé, Saad Nseir, Nicolas Terzi, Keyvan Razazi, Elie Azoulay, Alexis Ferré, Yacine Tandjaoui-Lambiotte, Olivier Ellrodt, Sami Hraiech, Clément DelmasFrançois Barbier, Alexandre Lautrette, Nadia Aissaoui, Xavier Repessé, Claire Pichereau, Yoann Zerbib, Jean Baptiste Lascarrou, Serge Carreira, Danielle Reuter, Aurélien Frérou, Vincent Peigne, Pierre Fillatre, Bruno Megarbane, Guillaume Voiriot, Alain Combes, Matthieu Schmidt

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Abstract

OBJECTIVES: Thyroid storm represents a rare but life-threatening endocrine emergency. Only rare data are available on its management and the outcome of the most severe forms requiring ICU admission. We aimed to describe the clinical manifestations, management and in-ICU and 6-month survival rates of patients with those most severe thyroid storm forms requiring ICU admission. DESIGN: Retrospective, multicenter, national study over an 18-year period (2000-2017). SETTING: Thirty-one French ICUs. PATIENTS: The local medical records of patients from each participating ICU were screened using the International Classification of Diseases, 10th Revision. Inclusion criteria were "definite thyroid storm," as defined by the Japanese Thyroid Association criteria, and at least one thyroid storm-related organ failure. MEASUREMENTS AND MAIN RESULTS: Ninety-two patients were included in the study. Amiodarone-associated thyrotoxicosis and Graves' disease represented the main thyroid storm etiologies (30 [33%] and 24 [26%] patients, respectively), while hyperthyroidism was unknown in 29 patients (32%) before ICU admission. Amiodarone use (24 patients [26%]) and antithyroid-drug discontinuation (13 patients [14%]) were the main thyroid storm-triggering factors. No triggering factor was identified for 30 patients (33%). Thirty-five patients (38%) developed cardiogenic shock within the first 48 hours after ICU admission. In-ICU and 6-month postadmission mortality rates were 17% and 22%, respectively. ICU nonsurvivors more frequently required vasopressors, extracorporeal membrane of oxygenation, renal replacement therapy, mechanical ventilation, and/or therapeutic plasmapheresis. Multivariable analyses retained Sequential Organ Failure Assessment score without cardiovascular component (odds ratio, 1.22; 95% CI, 1.03-1.46; p = 0.025) and cardiogenic shock within 48 hours post-ICU admission (odds ratio, 9.43; 1.77-50.12; p = 0.008) as being independently associated with in-ICU mortality. CONCLUSIONS: Thyroid storm requiring ICU admission causes high in-ICU mortality. Multiple organ failure and early cardiogenic shock seem to markedly impact the prognosis, suggesting a prompt identification and an aggressive management.

Original languageEnglish (US)
Pages (from-to)83-90
Number of pages8
JournalCritical care medicine
Volume48
Issue number1
DOIs
StatePublished - Jan 1 2020

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All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Bourcier, S., Coutrot, M., Kimmoun, A., Sonneville, R., de Montmollin, E., Persichini, R., Schnell, D., Charpentier, J., Aubron, C., Morawiec, E., Bigé, N., Nseir, S., Terzi, N., Razazi, K., Azoulay, E., Ferré, A., Tandjaoui-Lambiotte, Y., Ellrodt, O., Hraiech, S., ... Schmidt, M. (2020). Thyroid Storm in the ICU: A Retrospective Multicenter Study. Critical care medicine, 48(1), 83-90. https://doi.org/10.1097/CCM.0000000000004078