Table 2 The diagnostic criteria for thyroid storm of the Japan Thyroid Association
Prerequisite for diagnosis | ||
Presence of thyrotoxicosis with elevated levels of free triiodothyronine (FT3) or free thyroxine (FT4) | ||
Symptoms | ||
1. Central nervous system (CNS) manifestations: restlessness, delirium, mental aberration/psychosis, somnolence/lethargy, coma (≥ 1 on the Japan Coma Scale or ≤ 14 on the Glasgow Coma Scale) | ||
2. Fever: ≥ 38 °C | ||
3. Tachycardia: ≥ 130 beats per minute or heart rate ≥ 130 in atrial fibrillation | ||
4. Congestive heart failure (CHF): pulmonary edema, moist rales over more than half of the lung field, cardiogenic shock, or New York Heart Association class IV or Killip ≥ Class III | ||
5. Gastrointestinal (GI)/hepatic manifestations: nausea, vomiting, diarrhea, or a total bilirubin level ≥ 3.0 mg/dL | ||
Diagnosis | ||
Grade of thyroid storm | Combinations of features | Requirements for diagnosis |
TS1 | First combination | Thyrotoxicosis and at least one CNS manifestation and fever, tachycardia, CHF, or GI/hepatic manifestations |
TS1 | Alternate combination | Thyrotoxicosis and at least three combinations of fever, tachycardia, CHF, or GI/hepatic manifestations |
TS2 | First combination | Thyrotoxicosis and a combination of two of the following: fever, tachycardia, CHF, or GI/hepatic manifestations |
TS2 | Alternate combination | Patients who met the diagnosis of TS1 except that serum FT3 or FT4 level are not available |
Exclusions and provisions | ||
Cases are excluded if other underlying diseases are clearly causing any of the following symptoms: fever (e.g., pneumonia and malignant hyperthermia), impaired consciousness (e.g., psychiatric disorders and cerebrovascular disease), heart failure (e.g., acute myocardial infarction), and liver disorders (e.g., viral hepatitis and acute liver failure). Therefore, it is difficult to determine whether the symptom is caused by thyroid storm or is simply a manifestation of an underlying disease; the symptom should be regarded as being due to a thyroid storm that is caused by these precipitating factors. Clinical judgment in this matter is required | ||