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Article Dans Une Revue Critical Care Medicine Année : 2020

Thyroid Storm in the ICU

1 CHU Pitié-Salpêtrière [AP-HP]
2 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
3 Hôpital Delafontaine
4 CHU La Réunion - Centre Hospitalier Universitaire de La Réunion
5 CH Angoulême - Centre Hospitalier d'Angoulême
6 AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris]
7 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
8 CHU Saint-Antoine [AP-HP]
9 CHRU Lille - Centre Hospitalier Régional Universitaire [Lille]
10 Université de Lille
11 CHU - Centre Hospitalier Universitaire [Grenoble]
12 CHU Henri Mondor [Créteil]
13 AP-HP - Hopital Saint-Louis [AP-HP]
14 CHV - Centre Hospitalier de Versailles André Mignot
15 Hôpital Avicenne [AP-HP]
16 Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun,
17 Hôpital Nord [CHU - APHM]
18 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
19 CHRO - Centre Hospitalier Régional d'Orléans
20 CHU Clermont-Ferrand
21 HEGP - Hôpital Européen Georges Pompidou [APHP]
22 Hôpital Ambroise Paré [AP-HP]
23 Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy]
24 CHU Amiens-Picardie
25 CHU Nantes - Centre hospitalier universitaire de Nantes
26 CHU Pontchaillou [Rennes]
27 Centre Hospitalier Métropole Savoie [Chambéry]
28 CHU de Saint-Brieuc
29 Hôpital Lariboisière-Fernand-Widal [APHP]
30 CHU Tenon [AP-HP]
31 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
Simon Bourcier
Antoine Kimmoun
  • Fonction : Auteur
  • PersonId : 782318
  • IdRef : 150592183
David Schnell
Naïke Bigé
Nicolas Terzi
Yacine Tandjaoui-Lambiotte
Yoann Zerbib
  • Fonction : Auteur
Serge Carreira
  • Fonction : Auteur
Danielle Reuter
  • Fonction : Auteur


Objectives: Thyroid storm represents a rare but life-threatening endocrine emergency. Only rare data are available on its management and the outcome of the most severe forms requiring ICU admission. We aimed to describe the clinical manifestations, management and in-ICU and 6-month survival rates of patients with those most severe thyroid storm forms requiring ICU admission. Design: Retrospective, multicenter, national study over an 18-year period (2000–2017). Setting: Thirty-one French ICUs. Patients: The local medical records of patients from each participating ICU were screened using the International Classification of Diseases, 10th Revision. Inclusion criteria were “definite thyroid storm,” as defined by the Japanese Thyroid Association criteria, and at least one thyroid storm-related organ failure. Measurements and Main Results: Ninety-two patients were included in the study. Amiodarone-associated thyrotoxicosis and Graves’ disease represented the main thyroid storm etiologies (30 [33%] and 24 [26%] patients, respectively), while hyperthyroidism was unknown in 29 patients (32%) before ICU admission. Amiodarone use (24 patients [26%]) and antithyroid-drug discontinuation (13 patients [14%]) were the main thyroid storm-triggering factors. No triggering factor was identified for 30 patients (33%). Thirty-five patients (38%) developed cardiogenic shock within the first 48 hours after ICU admission. In-ICU and 6-month postadmission mortality rates were 17% and 22%, respectively. ICU nonsurvivors more frequently required vasopressors, extracorporeal membrane of oxygenation, renal replacement therapy, mechanical ventilation, and/or therapeutic plasmapheresis. Multivariable analyses retained Sequential Organ Failure Assessment score without cardiovascular component (odds ratio, 1.22; 95% CI, 1.03–1.46; p = 0.025) and cardiogenic shock within 48 hours post-ICU admission (odds ratio, 9.43; 1.77–50.12; p = 0.008) as being independently associated with in-ICU mortality. Conclusions: Thyroid storm requiring ICU admission causes high in-ICU mortality. Multiple organ failure and early cardiogenic shock seem to markedly impact the prognosis, suggesting a prompt identification and an aggressive management.
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Dates et versions

hal-03324207 , version 1 (23-08-2021)



Simon Bourcier, Maxime Coutrot, Antoine Kimmoun, Romain Sonneville, Etienne de Montmollin, et al.. Thyroid Storm in the ICU. Critical Care Medicine, 2020, Critical Care Medicine, 48 (1), pp.83-90. ⟨10.1097/ccm.0000000000004078⟩. ⟨hal-03324207⟩
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