Clinical Experience : GRAVES ’ DISEASE AND THYROID STORM

Thyroid Storm (TS) or Thyroid Crisis (TC) usually develops after some specific precipitating event such as infection, sepsis, trauma, cerebrovascular accident, or radioactive iodine therapy, etc. Thyroid Crisis may present as the so called masked or apapthic thyrotoxicosis (Ghobrial et al 2002), in which case signs and symptoms of the patient may be subtle, or not previously diagnosed with thyrotoxicosis (Hughes et al 2003). The clinical picture reflexes to severely exaggerated effects of thyroid hormones (THs). Heat intolerance and diaphoresis are common in simple thyrotoxicosis but manifest as hyperpyrexia in TS. The temperature is consistently higher than 38.5°C, but frequently exceeds 40°C. Excessive sweating may be frequently exist. In addition to the thermoregulatory dysfunction, other cardinal systems, such as CNS, Gastrointestinal-Hepatic System, and Cardiovascular System are fundamentally involved. Diagnosis of TS is primarily clinical based, and no specific laboratory tests are available. However, Burch-Wartofsky Point Score (BWPS) can be used as diagnostic criteria for TS (Burch et al 1993, Tietgens et al 1995). Formula 41668 (Tjokroprawiro 2002) and the revised Formula TS 41668-24-6 (Tjokroprawiro 2005) have been routinely used in Surabaya as guidelines of specific treatment of TS and for evaluation of its therapeutic clinical outcomes. Thyroid Crisis is an acute, life-threatening emergency with extremely high mortality (90%) in USA if early diagnosis is not made and the patients is left untreated. However, with better control of tyrotoxicosis and early treatment of TS, the mortality has decreased to less than 20%. This presentation or paper is intended for residents of internal medicine, internists, candidates of endocrinologists, and associated specialists, to recognize the rational therapy of TS, the Formula TS 41668-24-6 as its practical guidelines and to know how to apply the Formula CS 737 for the rationale administration of corticosteroid treatment.