Early thyroid resection as a treatment of thyroid storm

Introduction: Thyroid storm is a rare disease, occurring in less than 1 % o f all thyrotoxicoses. Diagnosis and therapy still have serious problems. Me thods: We review 14 patients who were operated on between 1992 and 1999 bec ause of thyroid storm. Results: All of the ten women and four men, aged 27 to 77 years, had an underlying thyroid disease. Autonomies were found in se ven, Grave's disease in four, and a nodular goiter in three patients. The p recipitating events were in five patients an antiarrhythmic therapy with am iodarone, on three occasions application of contrast medium, two times omis sion of antithyroid drugs and in one patient severe hyperglycemia with acid osis. In three patients no triggering factor was discovered. All patients w ere treated with high-dose antithyroid therapy. On admission, four patients were graded as stage-one thyroid crisis, three patients had stage-two and seven patients stage-three disease. All patients were operated on within 18 h of admission. Surgical procedure was in seven cases a bilateral subtotal resection, four times thyroidectomy, and in three patients a Dunhill proce dure. After the operation, 12 patients improved rapidly. Two 77 and 74-year -old women died 1 or 2 days after the operation, respectively, one from hea rt failure and the other from multiple organ failure. Both had been diagnos ed as thyrotoxic crisis stage three. Conclusion: Early operation should be adopted as a standard option in thyroid storm that cannot be controlled med ically. Best results are achieved if the operation is done at stage one or two of the disease.