Prospective Multicenter Registry-Based Study on Thyroid Storm: The Guidelines for the Management from Japan are Useful

Yasushi Furukawa; Keiko Tanaka; Osamu Isozaki; Atsushi Suzuki; Tadao Iburi; Kumiko Tsuboi; Moritake Iguchi; Naotetsu Kanamoto; Kanshi Minamitani; Shu Wakino; Tetsurou Satoh; Satoshi Teramukai; Eizen Kimura; Yoshihiro Miyake; Takashi Akamizu

doi:10.1210/clinem/dgae124

Prospective Multicenter Registry-Based Study on Thyroid Storm: The Guidelines for the Management from Japan are Useful

J Clin Endocrinol Metab. 2024 Mar 8:dgae124. doi: 10.1210/clinem/dgae124. Online ahead of print.

Authors

Affiliations

¹ First Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
² Department of Epidemiology and Public Health, Ehime University Graduate School of Medicine, Ehime, Japan.
³ Wakamatsukawada Clinic, Tokyo, Japan.
⁴ Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, Aichi, Japan.
⁵ Diabetes, Endocrinology, and Metabolism, Takashimadaira Chuo General Hospital, Tokyo, Japan.
⁶ Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University School of Medicine, Tokyo, Japan.
⁷ Department of Cardiac Rehabilitation, National Hospital Organization Kyoto Medical Center Kyoto, Japan.
⁸ Department of Endocrinology, Osaka City General Hospital, Osaka, Japan.
⁹ Department of Pediatrics, Teikyo University Chiba Medical Center, Chiba, Japan.
¹⁰ Department of Nephrology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
¹¹ Jounan clinic, Gunma, Japan.
¹² Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹³ Department of Medical Informatics, Ehime University Graduate School of Medicine, Ehime, Japan.
¹⁴ Departmentof Internal Medicine, Kuma Hospital, Kobe, Japan.

PMID: 38454797
DOI: 10.1210/clinem/dgae124

Abstract

Context: The mortality rate in thyroid storm (TS) has been reported to be higher than 10%.

Objective: We aimed to evaluate the effectiveness of the 2016 guidelines for the management of TS proposed by the Japan Thyroid Association and Japan Endocrine Society.

Design: Prospective registry-based study through a secure web platform.

Setting: Prospective multicenter registry.

Patients and measurements: Patients with new-onset TS were registered in the Research Electronic Data Capture (REDCap). On day 30 after admission, clinical information and prognosis of each patient were added to the platform. On day 180, the prognosis was described.

Results: This study included 110 patients with TS. The median of Acute Physiology and Chronic Health Evaluation (APACHE) II score was 13, higher than the score in the previous nationwide epidemiological study, 10 (p = 0.001). Nonetheless, the mortality rate at day 30 was 5.5%, approximately half compared with 10.7% in the previous nationwide survey. Lower body mass index, shock and lower left ventricular ejection fraction were positively associated with poor prognosis at day 30, while the lack of fever ≥ 38℃ was related to the outcome. The mortality rate in patients with an APACHE II score ≥12 for whom the guidelines were not followed was significantly higher than the rate in patients for whom the guidelines were followed (50% vs. 4.7%) (p = 0.01).

Conclusions: Prognosis seemed better than in the previous nationwide survey, even though disease severity was higher. The mortality rate was lower when the guidelines were followed. Thus, the guidelines are useful for managing TS.

Keywords: Graves’ disease; REDCap; epidemiology; prospective; thyroid crisis; thyrotoxicosis.