Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys

Takashi Akamizu, Tetsurou Satoh, Osamu Isozaki, Atsushi Suzuki, Shu Wakino, Tadao Iburi, Kumiko Tsuboi, Tsuyoshi Monden, Tsuyoshi Kouki, Hajime Otani, Satoshi Teramukai, Ritei Uehara, Yosikazu Nakamura, Masaki Nagai, Masatomo Mori

Research output: Contribution to journalArticle

114 Citations (Scopus)

Abstract

Background: Thyroid storm (TS) is life threatening. Its incidence is poorly defined, few series are available, and population-based diagnostic criteria have not been established. We surveyed TS in Japan, defined its characteristics, and formulated diagnostic criteria, FINAL-CRITERIA1 and FINAL-CRITERIA2, for two grades of TS, TS1, and TS2 respectively. Methods: We first developed diagnostic criteria based on 99 patients in the literature and 7 of our patients (LIT-CRITERIA1 for TS1 and LIT-CRITERIA2 for TS2). Thyrotoxicosis was a prerequisite for TS1 and TS2 as well as for combinations of the central nervous system manifestations, fever, tachycardia, congestive heart failure (CHF), and gastrointestinal (GI)/hepatic disturbances. We then conducted initial and follow-up surveys from 2004 through 2008, targeting all hospitals in Japan, with an eight-layered random extraction selection process to obtain and verify information on patients who met LIT-CRITERIA1 and LIT-CRITERIA2. Results: We identified 282 patients with TS1 and 74 patients with TS2. Based on these data and information from the Ministry of Health, Labor, and Welfare of Japan, we estimated the incidence of TS in hospitalized patients in Japan to be 0.20 per 100,000 per year. Serum-free thyroxine and free triiodothyroine concentrations were similar among patients with TS in the literature, Japanese patients with TS1 or TS2, and a group of patients with thyrotoxicosis without TS (Tox-NoTS). The mortality rate was 11.0% in TS1, 9.5% in TS2, and 0% in Tox-NoTS patients. Multiple organ failure was the most common cause of death in TS1 and TS2, followed by CHF, respiratory failure, arrhythmia, disseminated intravascular coagulation, GI perforation, hypoxic brain syndrome, and sepsis. Glasgow Coma Scale results and blood urea nitrogen (BUN) were associated with irreversible damages in 22 survivors. The only change in our final diagnostic criteria for TS as compared with our initial criteria related to serum bilirubin concentration >3 mg/dL. Conclusions: TS is still a life-threatening disorder with more than 10% mortality in Japan. We present newly formulated diagnostic criteria for TS and clarify its clinical features, prognosis, and incidence based on nationwide surveys in Japan. This information will help diagnose TS and in understanding the factors contributing to mortality and irreversible complications.

Original languageEnglish
Pages (from-to)661-679
Number of pages19
JournalThyroid
Volume22
Issue number7
DOIs
Publication statusPublished - 01-07-2012

Fingerprint

Thyroid Crisis
Incidence
Japan
Thyrotoxicosis
Mortality
Heart Failure
Surveys and Questionnaires
Systemic Inflammatory Response Syndrome
Glasgow Coma Scale
Multiple Organ Failure
Disseminated Intravascular Coagulation
Blood Urea Nitrogen
Serum
Thyroxine
Bilirubin
Tachycardia
Respiratory Insufficiency
Survivors
Cardiac Arrhythmias
Cause of Death

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Akamizu, Takashi ; Satoh, Tetsurou ; Isozaki, Osamu ; Suzuki, Atsushi ; Wakino, Shu ; Iburi, Tadao ; Tsuboi, Kumiko ; Monden, Tsuyoshi ; Kouki, Tsuyoshi ; Otani, Hajime ; Teramukai, Satoshi ; Uehara, Ritei ; Nakamura, Yosikazu ; Nagai, Masaki ; Mori, Masatomo. / Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. In: Thyroid. 2012 ; Vol. 22, No. 7. pp. 661-679.
@article{edaf8109323f4bca932e3e3034376d51,
title = "Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys",
abstract = "Background: Thyroid storm (TS) is life threatening. Its incidence is poorly defined, few series are available, and population-based diagnostic criteria have not been established. We surveyed TS in Japan, defined its characteristics, and formulated diagnostic criteria, FINAL-CRITERIA1 and FINAL-CRITERIA2, for two grades of TS, TS1, and TS2 respectively. Methods: We first developed diagnostic criteria based on 99 patients in the literature and 7 of our patients (LIT-CRITERIA1 for TS1 and LIT-CRITERIA2 for TS2). Thyrotoxicosis was a prerequisite for TS1 and TS2 as well as for combinations of the central nervous system manifestations, fever, tachycardia, congestive heart failure (CHF), and gastrointestinal (GI)/hepatic disturbances. We then conducted initial and follow-up surveys from 2004 through 2008, targeting all hospitals in Japan, with an eight-layered random extraction selection process to obtain and verify information on patients who met LIT-CRITERIA1 and LIT-CRITERIA2. Results: We identified 282 patients with TS1 and 74 patients with TS2. Based on these data and information from the Ministry of Health, Labor, and Welfare of Japan, we estimated the incidence of TS in hospitalized patients in Japan to be 0.20 per 100,000 per year. Serum-free thyroxine and free triiodothyroine concentrations were similar among patients with TS in the literature, Japanese patients with TS1 or TS2, and a group of patients with thyrotoxicosis without TS (Tox-NoTS). The mortality rate was 11.0{\%} in TS1, 9.5{\%} in TS2, and 0{\%} in Tox-NoTS patients. Multiple organ failure was the most common cause of death in TS1 and TS2, followed by CHF, respiratory failure, arrhythmia, disseminated intravascular coagulation, GI perforation, hypoxic brain syndrome, and sepsis. Glasgow Coma Scale results and blood urea nitrogen (BUN) were associated with irreversible damages in 22 survivors. The only change in our final diagnostic criteria for TS as compared with our initial criteria related to serum bilirubin concentration >3 mg/dL. Conclusions: TS is still a life-threatening disorder with more than 10{\%} mortality in Japan. We present newly formulated diagnostic criteria for TS and clarify its clinical features, prognosis, and incidence based on nationwide surveys in Japan. This information will help diagnose TS and in understanding the factors contributing to mortality and irreversible complications.",
author = "Takashi Akamizu and Tetsurou Satoh and Osamu Isozaki and Atsushi Suzuki and Shu Wakino and Tadao Iburi and Kumiko Tsuboi and Tsuyoshi Monden and Tsuyoshi Kouki and Hajime Otani and Satoshi Teramukai and Ritei Uehara and Yosikazu Nakamura and Masaki Nagai and Masatomo Mori",
year = "2012",
month = "7",
day = "1",
doi = "10.1089/thy.2011.0334",
language = "English",
volume = "22",
pages = "661--679",
journal = "Thyroid",
issn = "1050-7256",
publisher = "Mary Ann Liebert Inc.",
number = "7",

}

Akamizu, T, Satoh, T, Isozaki, O, Suzuki, A, Wakino, S, Iburi, T, Tsuboi, K, Monden, T, Kouki, T, Otani, H, Teramukai, S, Uehara, R, Nakamura, Y, Nagai, M & Mori, M 2012, 'Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys', Thyroid, vol. 22, no. 7, pp. 661-679. https://doi.org/10.1089/thy.2011.0334

Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. / Akamizu, Takashi; Satoh, Tetsurou; Isozaki, Osamu; Suzuki, Atsushi; Wakino, Shu; Iburi, Tadao; Tsuboi, Kumiko; Monden, Tsuyoshi; Kouki, Tsuyoshi; Otani, Hajime; Teramukai, Satoshi; Uehara, Ritei; Nakamura, Yosikazu; Nagai, Masaki; Mori, Masatomo.

In: Thyroid, Vol. 22, No. 7, 01.07.2012, p. 661-679.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys

AU - Akamizu, Takashi

AU - Satoh, Tetsurou

AU - Isozaki, Osamu

AU - Suzuki, Atsushi

AU - Wakino, Shu

AU - Iburi, Tadao

AU - Tsuboi, Kumiko

AU - Monden, Tsuyoshi

AU - Kouki, Tsuyoshi

AU - Otani, Hajime

AU - Teramukai, Satoshi

AU - Uehara, Ritei

AU - Nakamura, Yosikazu

AU - Nagai, Masaki

AU - Mori, Masatomo

PY - 2012/7/1

Y1 - 2012/7/1

N2 - Background: Thyroid storm (TS) is life threatening. Its incidence is poorly defined, few series are available, and population-based diagnostic criteria have not been established. We surveyed TS in Japan, defined its characteristics, and formulated diagnostic criteria, FINAL-CRITERIA1 and FINAL-CRITERIA2, for two grades of TS, TS1, and TS2 respectively. Methods: We first developed diagnostic criteria based on 99 patients in the literature and 7 of our patients (LIT-CRITERIA1 for TS1 and LIT-CRITERIA2 for TS2). Thyrotoxicosis was a prerequisite for TS1 and TS2 as well as for combinations of the central nervous system manifestations, fever, tachycardia, congestive heart failure (CHF), and gastrointestinal (GI)/hepatic disturbances. We then conducted initial and follow-up surveys from 2004 through 2008, targeting all hospitals in Japan, with an eight-layered random extraction selection process to obtain and verify information on patients who met LIT-CRITERIA1 and LIT-CRITERIA2. Results: We identified 282 patients with TS1 and 74 patients with TS2. Based on these data and information from the Ministry of Health, Labor, and Welfare of Japan, we estimated the incidence of TS in hospitalized patients in Japan to be 0.20 per 100,000 per year. Serum-free thyroxine and free triiodothyroine concentrations were similar among patients with TS in the literature, Japanese patients with TS1 or TS2, and a group of patients with thyrotoxicosis without TS (Tox-NoTS). The mortality rate was 11.0% in TS1, 9.5% in TS2, and 0% in Tox-NoTS patients. Multiple organ failure was the most common cause of death in TS1 and TS2, followed by CHF, respiratory failure, arrhythmia, disseminated intravascular coagulation, GI perforation, hypoxic brain syndrome, and sepsis. Glasgow Coma Scale results and blood urea nitrogen (BUN) were associated with irreversible damages in 22 survivors. The only change in our final diagnostic criteria for TS as compared with our initial criteria related to serum bilirubin concentration >3 mg/dL. Conclusions: TS is still a life-threatening disorder with more than 10% mortality in Japan. We present newly formulated diagnostic criteria for TS and clarify its clinical features, prognosis, and incidence based on nationwide surveys in Japan. This information will help diagnose TS and in understanding the factors contributing to mortality and irreversible complications.

AB - Background: Thyroid storm (TS) is life threatening. Its incidence is poorly defined, few series are available, and population-based diagnostic criteria have not been established. We surveyed TS in Japan, defined its characteristics, and formulated diagnostic criteria, FINAL-CRITERIA1 and FINAL-CRITERIA2, for two grades of TS, TS1, and TS2 respectively. Methods: We first developed diagnostic criteria based on 99 patients in the literature and 7 of our patients (LIT-CRITERIA1 for TS1 and LIT-CRITERIA2 for TS2). Thyrotoxicosis was a prerequisite for TS1 and TS2 as well as for combinations of the central nervous system manifestations, fever, tachycardia, congestive heart failure (CHF), and gastrointestinal (GI)/hepatic disturbances. We then conducted initial and follow-up surveys from 2004 through 2008, targeting all hospitals in Japan, with an eight-layered random extraction selection process to obtain and verify information on patients who met LIT-CRITERIA1 and LIT-CRITERIA2. Results: We identified 282 patients with TS1 and 74 patients with TS2. Based on these data and information from the Ministry of Health, Labor, and Welfare of Japan, we estimated the incidence of TS in hospitalized patients in Japan to be 0.20 per 100,000 per year. Serum-free thyroxine and free triiodothyroine concentrations were similar among patients with TS in the literature, Japanese patients with TS1 or TS2, and a group of patients with thyrotoxicosis without TS (Tox-NoTS). The mortality rate was 11.0% in TS1, 9.5% in TS2, and 0% in Tox-NoTS patients. Multiple organ failure was the most common cause of death in TS1 and TS2, followed by CHF, respiratory failure, arrhythmia, disseminated intravascular coagulation, GI perforation, hypoxic brain syndrome, and sepsis. Glasgow Coma Scale results and blood urea nitrogen (BUN) were associated with irreversible damages in 22 survivors. The only change in our final diagnostic criteria for TS as compared with our initial criteria related to serum bilirubin concentration >3 mg/dL. Conclusions: TS is still a life-threatening disorder with more than 10% mortality in Japan. We present newly formulated diagnostic criteria for TS and clarify its clinical features, prognosis, and incidence based on nationwide surveys in Japan. This information will help diagnose TS and in understanding the factors contributing to mortality and irreversible complications.

UR - http://www.scopus.com/inward/record.url?scp=84863428154&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84863428154&partnerID=8YFLogxK

U2 - 10.1089/thy.2011.0334

DO - 10.1089/thy.2011.0334

M3 - Article

C2 - 22690898

AN - SCOPUS:84863428154

VL - 22

SP - 661

EP - 679

JO - Thyroid

JF - Thyroid

SN - 1050-7256

IS - 7

ER -