[SueAndHerZoo]

#1059826

OK, exactly how afraid of Thyroid Storm should we be? When I first started hearing the term and reading about it it scared the crap out of me and I became a hypochondriac and lived in a state of fear that it would happen any minute and I’d be a goner! After a trip to the ER a few weeks ago I am now calmer about it but I’m reading that it sometimes happens during TT?

Since I’m thinking about considering TT in the future, should that be a factor to weigh into the decision? I mean, even if it DID happen during surgery, isn’t that the perfect place to be so they can “fix it”?
Sue

[Kimberly]

#1178011

Hello – I haven’t seen any specific stats, but from my experience, the VAST majority of people who experience thyroid storm have not been diagnosed and are not being treated.

Thyroid storm is a risk in *any* surgery if the patient is hyperthyroid. That’s why the preference is to get patients stable first via Anti-Thyroid Drugs. (Although beta blockers and potassium iodide can also help reduce this risk).

[ChristinaDe]

#1178012

Sue,

My surgeon told me that there is a risk of thyroid storm during TT…IF precautions are not taken in advance & IF they operate on a markedly hyper thyroid. Therefore, he preferred that my thyroid levels were stabilized first on ATDs, that I was on a beta blocker for at least a week prior & a week after surgery, and he had me take prescription iodine drops called SSRI I think (not radioactive) for the week or 10 days just prior to the procedure. He also wanted my calcium and Vitamin D levels checked prior to surgery & if either were low he wanted me to begin supplementation.

My surgeon is in the top 10% nationally for thyroids & neck glands are pretty much all he does. Taking precautions up front minimizes the risk & he says this hasn’t been a problem in his surgeries. I got through mine without incident.

Christina

[adenure]

#1178013

My surgeon said the most important thing is to have the heart rate stable (via ATD’s or betablockers) and ideally, to have the patient euthyroid (thyroid hormones in range) for surgery. Also the potassium iodine drops (SSKI drops) make the thyroid less vascular and easier to operate on. If you have all those in check, then you’re probably good to go. I know of people who have been operated on even though they are not euthyroid, but were on betablockers and the surgery went fine. A friend of mine who had been on ATD’s on and off for 10 years ended up in the emergency room bc of thyroid storm. She was put on betablockers and operated on a few weeks later. She was and is fine now. Thyroid storm happened to her bc she was hyperthyroid, not getting labs done, and was not on any meds/ ATD’s. She also worked long hours and had some very stressful things going on in her life (divorce, trying to find a home to live in, carpool for her kids for school, driving far to work, long hours- ). Fortunately, she is okay now.

[SueAndHerZoo]

#1178014

OK, I’d like to dig a littlle deeper if I may….

What exactly IS thyroid storm? I’m guessing it’s when an already hyper thyroid all of a sudden revs up to a level where certain organs go into a life-threatening frenzy?

Why would thyroid storm happen when you are on a table having your thyroid removed? And even if surgery DID cause a big release of hormone, why is it serious? You are hooked up to all sorts of monitors and have a staff medical professionals right there to intercept, right?

I guess I don’t understand what it is, how it happens, and what needs to be done when it happens. All I know is that it’s supposedly a life-threatening condition and that scares the sh/t out of me!
Sue

[brondack]

#1178015

For the record, as Kimberly has said, it is a concern for ANY surgery. As it turns out, I was diagnosed with Graves and a hernia (totally unrelated obviously) at my annual physical last November. I scheduled a pre-op visit with the recommended hernia surgeon and he confirmed (as I expected) that nothing would be scheduled until I was “normal” and he was VERY adamant about that.

I am assuming that he meant thryoid normal rather than brain normal because my kids say I will never have the surgery if that is the case. :}

So, I have been taking Methimazole, in various doses, since then under the direction of a noted Endo and my levels have not yet stabilized to the point of being able to schedule the surgery.

[snelsen]

#1178016

Ok, Sue, here you go with a valid source:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001437/

For the record, thyroid storm is absolutely not a risk fro ANY surgery.
Not sure what reference that is, maybe you can help me with that, rondack.

What Kimberly said, was that a thyroid storm is a risk if the patient is hyperthyroid. The way she wrote it is clear to me, but may be easily misunderstood. I am sure she means ANY thyroidectomy, which is the topic we are discussing.

Adenur (Alexis) said it pretty clearly, plus some of the other posts. Christina Dee summarized it beautifully.

The goal:
use ATD’s to decrease excess thyroid hormone production that is happening because of Graves’. That is what Graves’ is.

As Alexis said, SSKI drops (Saturated Solution of Potassium Iodide) is given before the surgery to reduce the vascularity of the thyroid gland, ie, decrease the increased blood flow (cause of the enlarged thyroid=Graves’.

The beta blockers are used so that you have a normal heart rate, rather than a crazy fast one (called tachycardia, usually over 100 bpm (beats per minute) as defined by the American Heart Association.
So, the whole goal is to get as normal as possible, with heart rate, blood pressure and thyroid hormone.

Being hyperthyroid can be life threatening. So goal is to get us safe until a permanent treatment can be decided upon.

Digging deeper”
To clarify, you may have misunderstood this. Surgery does not cause a big release of hormone. But after surgery, we still have thyroid hormone flowing around which was there before the surgery. That is why we have labs.

It is realistic and reasonable to be scared of thyroid storm…if a person refuses treatment for hyperthyroidism, and develops the symptoms as described in the NIH information above. Just as it is realistic and reasonable to be scared if you are a diabetic who refuses treatment, to name another good example.

It is my thought that a good surgeon won’t ever elect to operate of a patient who is very hyperthyroid with the extreme symptoms of heart rate and BP out of control. Why would they do that? Better to do the ATD’s first.

Well then, when a person cannot take ATD’s, it is very possible, then a good surgeon might weigh the danger of being hyperthyroid, against carefully preparing the person for surgery as described above. Yes, there are all kinds of monitors in the OR, and the patient would be fine, for anesthesia can control everything. Just like the ER docs would do if someone came in with a racing pulse of 180 and a BP of 180/120. They could manage those two things without knowing the precise diagnosis, even if it weren’t Graves’. They would be doing other tests at the same time if they did not have any information at all. (could be a whole laundry list of stuff, including a hemorrhage someplace or a brain bleed.

So, it is a good idea to talk to your surgeon about all of this. Cause we are not pros here, just plain ole’ fellow Graves’ folk.
Shirley

[Kimberly]

#1178017

Hello – thyroid storm can potentially be triggered by any type of surgery. This link is to a great reference site. The first couple of paragraphs have some good info on thyroid storm, although you have to be a subscriber to get the full information.

(Note on links: if you click directly on the following link, you will need to use your browser’s “back” button to return to the boards after viewing, or you will have to log back in to the forum. As an alternative, you can right-click the link and open it in a new tab or new window).

http://www.uptodate.com/contents/thyroid-storm

Hope this helps!

[snelsen]

#1178018

I read all their references. All of them refer to Graves’ and hyperthyroidism.
I still think that to infer that with “any” surgery, that thyroid storm is very misleading information.
The operative consents for all surgeries are super inclusive. But I have never read one that states thyroid storm as a possibility as an outcome or side effect.
The references all refer to hyperthyroidism and/or Graves’.
Shirley

[Kimberly]

#1178019

Hi Shirley – Just to clarify my comments, for someone who is not hyperthyroid, there is *not* a risk for thyroid storm coming out of the blue from having surgery.

For patients who *are* hyperthyroid, the “Up to Date” link notes that risk of thyroid storm is increased with any surgery, not just thyroidectomy.

[Author]

Posts