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In-hospital mortality rate increases with thyrotoxicosis, thyroid storm
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AUSTIN, Texas — Adults with thyrotoxicosis also diagnosed with thyroid storm have a longer in-hospital stay, in-hospital mortality rate and higher admission costs compared with adults with thyrotoxicosis without thyroid storm.
Guillermo E. Umpierrez, MD, CDE, and colleagues used data from the National Inpatient Sample (NIS) to determine the incidence, in-hospital mortality and hospitalization costs for patients with thyrotoxicosis with or without thyroid storm. The analysis included 133,126 adults (mean age, 50 years; 78% women) admitted with a primary diagnosis of thyrotoxicosis from 2003 to 2013.
Overall, 21.886 participants were diagnosed with thyroid storm; the incidence rate ranged from 0.61 to 0.76 cases per 100,000 patients per year. Among hospitalized patients with thyrotoxicosis, the incidence of thyroid storm ranged from 14.2% to 18.4%.
Patients with thyrotoxicosis and thyroid storm had significantly higher in-hospital mortality (1.2% to 3.6%) compared with participants without thyroid storm (0.1% to 0.4%; P < .005), after multiple comparison adjustments. However, over time the in-hospital mortality rate was no longer significantly different between patients with or without thyroid storm.
The mean length of hospital stay was longer in those with thyroid storm: 4.82 to 5.66 mean days vs. 2.83 to 3.27 mean days (P < .001).
The researchers reported progressive increases in mean hospitalization costs per admission over the study period, from $22,369 to $48,042 in patients with thyrotoxicosis and thyroid storm vs. $15,406 to $28,966 for patients without thyroid storm (P < .001 for both).
“We are currently involved in a detailed analysis of patients admitted with thyroid storm in the United States,” Umpierrez, professor of medicine at Emory University and section head of diabetes and endocrinology at Grady Health System in Atlanta, told Endocrine Today. “We are investigating risk factors, precipitant conditions and comorbidities associated with thyroid storm. This information will allow clinicians to identify this high-risk population and implement early interventions.”
He also noted that the overall mortality associated with thyroid storm remains high and has not changed during the past decade. Moreover, treatment regimens for thyroid storm have not changed during the past decade.
Looking ahead, “future randomized studies are needed to determine the best treatment protocols to reduce the high mortality associated with this serious thyroid emergency,” Umpierrez said. – by Amber Cox
Reference:
Galindo R, et al. Abstract #1064. Presented at: AACE Annual Scientific and Clinical Congress; May 3-7, 2017; Austin, Texas.
Disclosure: Umpierrez reports no relevant financial disclosures.