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Thyroid storm substantially increases hospital mortality
The mortality rate for adults hospitalized with thyrotoxicosis and diagnosed with thyroid storm is significantly higher than the rate of those with thyrotoxicosis alone, according to findings published in Thyroid.
“This is a rare condition with high morbidity and mortality and also increasing hospital costs,” Rodolfo J. Galindo, MD, assistant professor of medicine and clinical researcher in the division of endocrinology at Emory University School of Medicine, told Endocrine Today. “Thus, we recognized a call-for-action to create a prospective patient registry, including clinical, laboratory and treatment data, to inform future evidence-based management recommendations for this condition.”
Using data from the National Inpatient Sample database, Galindo and colleagues performed a retrospective study of adults discharged from U.S. hospitals between 2004 and 2013. All participants had a principal discharge diagnosis of thyrotoxicosis (n = 121,384; mean age, 48.7 years; 77.3% women).
In the study population, the researchers found 19,723 cases of thyroid storm, making up 16.2% of the total number of participants discharged with thyrotoxicosis. Cardiovascular conditions were more common in the participants with thyroid storm compared with those with thyrotoxicosis alone, including ventricular arrhythmias (P < .001), heart failure (P < .001), cardiac arrest (P < .001) and acute coronary syndrome (P < .001).
Based on these findings, the researchers estimated that the incidence of thyroid storm among U.S. residents was between 0.57 and 0.76 cases per 100,000 person per year from 2004 to 2013. In all hospitalized persons, the incidence was between 4.8 and 5.6 cases per 100,000 hospitalizations per year. The annual incidence rate for thyroid storm among adults hospitalized with hyperthyroidism was between 14.2% and 18.4%. Those with thyroid storm had a hospital mortality rate between 1.2% and 3.6%, which was higher than the range for adults with thyrotoxicosis alone (0.1%-0.4%; P < .007). After multivariate analysis, adults with thyroid storm still had a higher risk for hospital mortality (OR = 10.2; 95% CI, 7.1-14.6) vs. those with thyrotoxicosis and no thyroid storm.
Hospitalization costs and length of stay increased for adults with thyroid storm during the study period, with mean annual costs rising from $9,942 in 2004 to $12,661 in 2013, and mean length of stay increasing from 4.8 to 5.6 days during the same period (P < .001).
“Providers caring for patients in urgent care, emergency rooms and/or hospitals should be aware of the high morbidity and mortality of thyroid storm. Clinicians, including emergency medicine specialist, hospitalists and/or internists, should be adequately trained on the use of supportive care and thionamide drugs in patients with severe hyperthyroidism, and advised on consulting endocrinology specialists in a timely manner, since delaying treatment can lead to increased morbidity and mortality,” Galindo said. “However, with the shortage of endocrinologists in the country, this can be particularly challenging in regions where there is limited access to endocrinology specialists, such as rural and community hospitals. Collaborative efforts are needed to design standardized evidence-based strategies — not just expert opinion recommendations — to diagnose and treat these patients.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.