2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition) The Japan Thyroid Association and Japan Endocrine Society Taskforce Committee for the establishment of diagnostic criteria and nationwide surveys for thyroid storm [Opinion]

Tetsurou Satoh; Osamu Isozaki; Atsushi Suzuki; Shu Wakino; Tadao Iburi; Kumiko Tsuboi; Naotetsu Kanamoto; Hajime Otani; Yasushi Furukawa; Satoshi Teramukai; Takashi Akamizu

doi:10.1507/endocrj.EJ16-0336

OPINION

2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition)

The Japan Thyroid Association and Japan Endocrine Society Taskforce Committee for the establishment of diagnostic criteria and nationwide surveys for thyroid storm [Opinion]

Tetsurou Satoh, Osamu Isozaki, Atsushi Suzuki, Shu Wakino, Tadao Iburi, Kumiko Tsuboi, Naotetsu Kanamoto, Hajime Otani, Yasushi Furukawa, Satoshi Teramukai, Takashi Akamizu

Author information

Tetsurou Satoh
Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Gunma 371-8511, Japan
Osamu Isozaki
Department of Medicine 2, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
Atsushi Suzuki
Division of Endocrinology and Metabolism, Fujita Health University, Aichi 470-1192, Japan
Shu Wakino
Department of Endocrinology, Metabolism and Nephrology, Keio University, Tokyo 160-8582, Japan
Tadao Iburi
Department of Endocrinology, Tenri Hospital, Nara 632-8552, Japan
Kumiko Tsuboi
Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Toho University School of Medicine, Tokyo 143-8541, Japan
Naotetsu Kanamoto
Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
Hajime Otani
Department of Internal Medicine II, Kansai Medical University, Osaka 573-1010, Japan
Yasushi Furukawa
The First Department of Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
Satoshi Teramukai
Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Takashi Akamizu
The First Department of Medicine, Wakayama Medical University, Wakayama 641-8509, Japan

Keywords: Thyroid crisis, Diagnostic criteria, Prognosis assessment, Prevention, Thyrotoxicosis

JOURNAL FREE ACCESS

2016 Volume 63 Issue 12 Pages 1025-1064

DOI https://doi.org/10.1507/endocrj.EJ16-0336

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Abstract

Thyroid storm is an endocrine emergency which is characterized by multiple organ failure due to severe thyrotoxicosis, often associated with triggering illnesses. Early suspicion, prompt diagnosis and intensive treatment will improve survival in thyroid storm patients. Because of its rarity and high mortality, prospective intervention studies for the treatment of thyroid storm are difficult to carry out. We, the Japan Thyroid Association and Japan Endocrine Society taskforce committee, previously developed new diagnostic criteria and conducted nationwide surveys for thyroid storm in Japan. Detailed analyses of clinical data from 356 patients revealed that the mortality in Japan was still high (∼11%) and that multiple organ failure and acute heart failure were common causes of death. In addition, multimodal treatment with antithyroid drugs, inorganic iodide, corticosteroids and beta-adrenergic antagonists has been suggested to improve mortality of these patients. Based on the evidence obtained by nationwide surveys and additional literature searches, we herein established clinical guidelines for the management of thyroid storm. The present guideline includes 15 recommendations for the treatment of thyrotoxicosis and organ failure in the central nervous system, cardiovascular system, and hepato-gastrointestinal tract, admission criteria for the intensive care unit, and prognostic evaluation. We also proposed preventive approaches to thyroid storm, roles of definitive therapy, and future prospective trial plans for the treatment of thyroid storm. We hope that this guideline will be useful for many physicians all over the world as well as in Japan in the management of thyroid storm and the improvement of its outcome.

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