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Thyroid Storm in the ICU

Simon Bourcier 1 Maxime Coutrot 1 Antoine Kimmoun Romain Sonneville 2 Etienne de Montmollin 3 Romain Persichini 4 David Schnell 5 Julien Charpentier 6 Cécile Aubron 7 Elise Morawiec 1 Naïke Bigé 8 Saad Nseir 9, 10 Nicolas Terzi 11 Keyvan Razazi 12 Elie Azoulay 13 Alexis Ferré 14 Yacine Tandjaoui-Lambiotte 15 Olivier Ellrodt 16 Sami Hraiech 17 Clément Delmas 18 François Barbier 19 Alexandre Lautrette 20 Nadia Aissaoui 21 Xavier Repessé 22 Claire Pichereau 23 Yoann Zerbib 24 Jean-Baptiste Lascarrou 25 Serge Carreira Danielle Reuter Aurélien Frérou 26 Vincent Peigne 27 Pierre Fillatre 28 Bruno Megarbane 29 Guillaume Voiriot 30 Alain Combes 31 Matthieu Schmidt 31
Abstract : 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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https://hal.univ-lille.fr/hal-03324207
Contributeur : Lilloa Université de Lille <>
Soumis le : lundi 23 août 2021 - 13:25:58
Dernière modification le : mardi 24 août 2021 - 03:28:11

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

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