# A Retrospective Analysis of Thyroid Storm at a Tertiary Care Center in Northern India

## TL;DR

This study examines 15 thyroid storm cases in India, finding Graves' disease as the main cause and highlighting cardiovascular issues as the most common symptom.

## Contribution

The study provides insights into the clinical presentation and outcomes of thyroid storm in a Northern Indian tertiary care center.

## Key findings

- Graves' disease was the underlying cause in all 15 thyroid storm cases.
- Cardiovascular dysfunction was the most common presentation, affecting 92% of patients.
- Central nervous system dysfunction occurred in 42% of patients but with mild severity.

## Abstract

Introduction and aim: Thyroid storm is a rare, yet life‑threatening form of thyrotoxicosis, featured by exaggerated clinical symptoms and signs along with multiorgan dysfunction. It is almost fatal (80-100%) if left untreated, and even with treatment, it carries a mortality rate of 50%. This study aimed to investigate the demographic profiles, clinical and biochemical features, and outcomes of patients hospitalized with thyroid storm at our institution.

Material and methods: This retrospective cohort study was conducted in the department of endocrinology and metabolism from January 2015 to July 2024. Medical records of patients diagnosed and admitted with thyroid storm or impending storm and those with calculated Burch-Wartofsky score (BWS) of ≥45 were reviewed. Data on demographics, clinical features, laboratory results, treatment, and outcomes were collected from hospital records. Incomplete records and cases with BWS <45 were excluded. Data were entered into Microsoft Excel and analyzed using R software (Vienna, Austria: R Foundation for Statistical Computing) with descriptive statistics applied.

Results: A total of 15 patients were included in the study. Of these, 73% presented with thyroid storm, while 26% presented with impending storm. Ninety-two percent of the patients were female, and the mean age was 46.07±12.62 years. Graves’ disease was the underlying cause in all patients. Twenty-one percent had newly detected thyrotoxicosis, whereas 79% were known cases of Graves’ disease. Cardiovascular dysfunction was observed in 92% of patients, with atrial fibrillation seen in 28%. This was followed by gastrointestinal dysfunction in 85% and central nervous system dysfunction in 42% of patients, most commonly presenting as mild agitation. A precipitating factor was identified in 57% of cases, with respiratory tract infection being the most common. Deranged liver function tests were noted in 42% of patients. Among the 11 patients with thyrotoxic storm, one patient expired within 72 h of admission due to heart failure.

Conclusion: In our study, Graves’ disease was the underlying cause of thyrotoxicosis storm in all the patients. A predominant cardiovascular dysfunction, followed by gastrointestinal dysfunction, was the most common presentation. Notably, central nervous system (CNS) dysfunction was observed less frequently and with mild severity than reported in other studies. Thyroid storm is a potentially lethal presentation of thyrotoxicosis; early diagnosis and prompt treatment are lifesaving.