Authors' reply

S Kumar¹, N Moorthy¹, S Yadav², A Kapoor¹, DC Dale²,  
¹ Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
² Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Correspondence Address:
S Kumar
Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
India

Full Text

Sir,

We appreciate the letter addressing, the issues on diagnosis and management of thyroid storm in response to our article. [1],[2] We agree that Burch and Wartofsky [3] have delineated a scoring system in an effort to standardize and objectify thyroid storm, as compared with severe thyrotoxicosis. Similarly, a thyroid storm diagnostic criteria has been proposed by Japan Thyroid Association (JTA). [4] However, it is important to consider thyroid storm in patients with severe thyrotoxicosis with critical illness and treat them aggressively, rather than focus on specific definitions. [5] Thyroid storm represents the extreme manifestation of thyrotoxicosis primarily judged by clinical manifestations, and as authors rightly pointed out, thyroid function tests do not help in differentiating between these two conditions. Similarly, radiological or nuclear imaging may or may not add any further information. [5] We agree that a multidrug approach using anti-thyroid drugs, iodine, beta-blockers, and glucocorticoids is usually required for the management of thyroid storm. [5] As our patient manifested with rapidly worsening congestive heart failure, aggressive management of heart failure with diuretics, beta-blocker, ACE inhibitor, and carbimazole resulted in dramatic improvement. Interestingly, our patient also had thrombosis at multiple locations, which is again not included under scoring system proposed by Burch and Wartofsky. [3] Our patient also did not have any neurological manifestations. Even though glucocorticoids are routinely used in the management of thyroid storm, we recommend glucocorticoids in cases not responding to routine measures. Since our patient was planned for radioiodine ablation, she was not given iodine.

We thus conclude that thyroid storm an endocrinal emergency is primarily diagnosed based on the clinical manifestations that requires early recognition and institution of treatment regardless of scoring systems.

References