Disseminated intravascular coagulation as a frequent and critical complication of thyroid storm: a single-center retrospective survey

Abstract

Thyroid storm (TS) is a rare but fatal endocrine emergency with high mortality, and there have been few detailed reports on its severity and possible complications to date. Therefore, a single-center retrospective survey was conducted to comprehensively analyze the severity, treatments, and complications of patients with thyroid storm who were admitted to Kitasato University Hospital between 2012 and 2023. A total of 22 patients who experienced thyroid storm were extracted; 19 patients (86%) had Graves’ disease, among which 12 patients were newly diagnosed, and there were 4 fatalities (18.1%) during the study period. The median Acute Physiology and Chronic Health Evaluation II (APACHE II) score and median Sequential Organ Failure Assessment (SOFA) score were 20 and 5, respectively, and both scores were higher in critical patients who needed ventilation, continuous hemodialysis and filtration, therapeutic plasma exchange, percutaneous cardiopulmonary support, extracorporeal membrane oxygenation, or who finally died. Diagnostic criteria for disseminated intravascular coagulation (DIC) were met in five patients (23%) who had significantly higher scores on the Burch-Wartofsky Point Scale as well as APACHE II and SOFA scores than the other patients. Thus, DIC is a frequent and critical complication of TS, which can lead to severe consequences, suggesting the necessity of prompt and intensive management of these patients.