Tempête thyroïdienne et triage d'urgence endocrinien du coma myxœdème¶

Thyroid storm (thyrotoxic crisis) and myxedema coma (decompensated hypothyroidism) represent the two opposite, life-threatening extremes of thyroid gland dysfunction. In thyroid storm, a massive surge of active thyroid hormones (\(T_3\) and \(T_4\)) drives the body's metabolic engine into hyperdrive, causing extreme fever above \(40.0^\circ\text{C}\) (\(104.0^\circ\text{F}\)), racing heart rates above \(140\text{ beats per minute}\), atrial fibrillation, high-output heart failure, agitation, delirium, and fatal cardiovascular collapse. In myxedema coma, severe prolonged depletion of thyroid hormone slows every organ system to a near-standstill, resulting in profound hypothermia (core temperature often below \(35.0^\circ\text{C}\) or \(95.0^\circ\text{F}\)), dangerously slow heart rate, shallow hypoventilation with carbon dioxide buildup, low blood sugar, generalized non-pitting swelling, and coma. Because both conditions carry hospital mortality rates of 10 to 40 percent even with intensive care, immediate recognition, targeted temperature management (active cooling for thyroid storm versus passive insulation for myxedema coma), and avoiding deadly pre-hospital mistakes like giving aspirin or applying hot heating pads are critical to survival.

Fais ça maintenant¶

1. Call your local emergency number immediately and state either "Suspected Thyroid Storm" or "Suspected Myxedema Coma." Dial 911 in the United States and Canada, 112 across the European Union, 999 in the United Kingdom, or see all numéros d'urgence. Explicitly report the patient's known thyroid history (Graves' disease, Hashimoto's thyroiditis, prior thyroid surgery, radioactive iodine therapy, or amiodarone/lithium use) and whether they are hyperthermic and racing or hypothermic and stuporous.
2. Determine which extreme of thyroid emergency is occurring by checking temperature, pulse, skin, and mental state.
3. Thyroid Storm (Hypermetabolic): Hot, drenched in sweat, fever \(\ge 38.5^\circ\text{C}\text{ to }41.0^\circ\text{C}\) (\(101.3^\circ\text{F}\text{ to }105.8^\circ\text{F}\)), pulse racing \(> 130\text{ to }180\text{ bpm}\) (often irregular), severe tremor, extreme agitation or delirium, vomiting, diarrhea, or yellow eyes (jaundice).
4. Myxedema Coma (Hypometabolic): Ice-cold, dry, thick pale-yellowish skin, puffy eyelids and swollen tongue, body temperature \(< 35.5^\circ\text{C}\) (\(95.9^\circ\text{F}\)), pulse slow \(< 50\text{ bpm}\), slow shallow breathing, extreme drowsiness, confusion, or coma.
5. For Suspected Thyroid Storm: Begin active external cooling immediately and NEVER give aspirin. Strip off heavy clothing, point a fan at the patient, mist their skin with cool (not freezing) water, and apply wrapped ice packs or cool wet towels to the neck, armpits, and groin. If the patient is fully awake and able to swallow, you may give acetaminophen (paracetamol) for fever, but strictly forbid aspirin, bismuth subsalicylate (Pepto-Bismol), or NSAIDs. Keep them sitting semi-upright (45 degrees) if they are breathless from heart failure.
6. For Suspected Myxedema Coma: Protect the airway in the recovery position and apply PASSIVE blanket insulation only. Because an enlarged swollen tongue (macroglossia), throat edema, and depressed brain respiratory drive rapidly cause suffocation, roll an unconscious or stuporous patient onto their side in the recovery position and monitor every breath. Wrap them in dry blankets and raise the room thermostat, never applying heating pads, electric blankets, or hot water bottles.
7. Check blood sugar or look for overlapping Adrenal Crisis (Schmidt Syndrome). In myxedema coma, severe hypoglycemia is common and co-existing acute adrenal insufficiency occurs in 5 to 10 percent of cases. Never force food or liquid into the mouth of a drowsy patient; if they have a prescribed emergency hydrocortisone injection kit for co-existing Addison's disease, administer it per the adrenal crisis guide.
8. Gather all prescription bottles, supplement containers, and recent hospital discharge papers for the paramedics. Look specifically for anti-thyroid pills (methimazole, carbimazole, propylthiouracil [PTU]), thyroid hormone pills (levothyroxine, liothyronine), heart rhythm drugs (amiodarone), psychiatric drugs (lithium), cancer immunotherapy cards, or unlabelled "weight-loss / energy" supplements containing hidden bovine/porcine thyroid extract.

Endocrine emergency triage decision tree: Thyroid Storm vs. Myxedema Coma¶

Use this clinical flowchart to rapidly classify the patient's thyroid crisis and initiate the correct life-saving pre-hospital protocol while awaiting ambulance arrival.

flowchart TD
    Start["Patient with Known or Suspected Thyroid Disorder<br/>Develops Acute Altered Mental Status + Critical Sign Collapse"] --> VitalCheck{"Assess Core Temperature, Heart Rate,<br/>Skin Moisture, and Neuromuscular State"}

    VitalCheck -->|"HOT, SWEATY, & RACING:<br/>- Fever >= 38.5 C to 41 C (101.3-105.8 F)<br/>- Tachycardia > 130-180 bpm or AFib<br/>- Agitation, delirium, tremor, vomiting/diarrhea"| StormBranch["SUSPECTED THYROID STORM<br/>(Decompensated Thyrotoxicosis)"]

    StormBranch --> StormAction["IMMEDIATE THYROID STORM PROTOCOL:<br/>1. Call 911 / 112 / 999 ('Suspected Thyroid Storm')<br/>2. ACTIVE EXTERNAL COOLING: Fans, cool wet cloths, ice packs to axilla/groin<br/>3. STRICTLY NO ASPIRIN / SALICYLATES (displaces free T3/T4)<br/>4. Sit semi-upright (45 deg) if breathless / coughing pink froth<br/>5. Quiet dim room to reduce sympathetic adrenaline surges"]

    StormAction --> StormHospital["Hospital ICU Targeted Sequence:<br/>1. Beta-blocker (Propranolol or Esmolol; avoid if severe low-EF heart failure)<br/>2. Thionamide (PTU or Methimazole) to block new hormone synthesis<br/>3. Iodine (Lugol's / SSKI) WAIT >= 1 HOUR AFTER thionamide<br/>4. IV Hydrocortisone (100 mg) to block T4-to-T3 conversion"]

    VitalCheck -->|"COLD, PUFFY, & SLOW:<br/>- Hypothermia < 35.5 C (95.9 F) & no shivering<br/>- Bradycardia < 50 bpm & slow shallow breathing<br/>- Puffy face/tongue, dry doughy skin, stupor/coma"| MyxBranch["SUSPECTED MYXEDEMA COMA<br/>(Decompensated Severe Hypothyroidism)"]

    MyxBranch --> MyxAction["IMMEDIATE MYXEDEMA COMA PROTOCOL:<br/>1. Call 911 / 112 / 999 ('Suspected Myxedema Coma')<br/>2. AIRWAY FIRST: Lateral recovery position (swollen tongue/glottis risk)<br/>3. PASSIVE REWARMING ONLY: Dry blankets & warm room<br/>   (NO heating pads/electric blankets -> prevents fatal vasodilatory shock)<br/>4. Keep Nothing by Mouth (NPO); prepare for CPR if breathing stops"]

    MyxAction --> MyxHospital["Hospital ICU Targeted Sequence:<br/>1. Mechanical ventilation for hypercapnic respiratory failure<br/>2. IV Hydrocortisone (100 mg IV FIRST, before levothyroxine)<br/>3. IV Levothyroxine (T4) +/- Liothyronine (T3) loading<br/>4. IV Dextrose for hypoglycemia & cautious correction of hyponatremia"]

Comparaison face-à-face : Tempête thyroïdienne contre Coma myxœdème¶

Chaque système organique du corps humain possède des récepteurs d’hormones thyroïdiennes. Consultez ce tableau de comparaison clinique (basé sur les directives de l'American Thyroid Association [ATA], de la Japan Thyroid Association [JTA] et de l'European Thyroid Association [ETA]) pour voir comment des niveaux d'hormones opposés transforment le corps :

Part 1: Deep dive into Thyroid Storm (Thyrotoxic Crisis)¶

Why simple hyperthyroidism suddenly explodes into Thyroid Storm¶

Most patients with overactive thyroid glands (hyperthyroidism) live for months with mild weight loss, warm hands, and a slightly fast pulse without immediate danger. Thyroid storm occurs when an acute physical stress or medical trigger overwhelms the body's ability to tolerate excess hormone, causing a sudden spike in unbound (free) \(T_3\) and \(T_4\) alongside a massive upregulation of beta-adrenergic receptors on the heart and blood vessels.

Les déclencheurs courants qui précipitent la tempête thyroïdienne comprennent : 1. Arrêt brutal des médicaments antithyroïdiens (méthimazole, carbimazole ou propylthiouracile [PTU]) en raison du coût, d'une maladie ou d'effets secondaires. 2. Infection bactérienne ou virale aiguë (pneumonie, infection des voies urinaires, angine streptococcique, COVID-19 ou état septique). 3. Charge massive en iode (phénomène Jod-Basedow) : Recevoir un produit de contraste CT iodé par voie intraveineuse, prendre de l'amiodarone (chaque comprimé d'amiodarone de 200 \(\text{ mg}\) contient 75 \(\text{ mg}\) d'iode organique, soit 500 fois les besoins quotidiens en iode humain) ou prendre des suppléments de varech/algues. 4. Chirurgie non thyroïdienne, traumatisme, accouchement ou acidocétose diabétique (DKA). 5. ** Palpation vigoureuse ou traumatisme d'un goitre hypertrophié **, ou thérapie récente à l'iode radioactif (\(^{131}\text{I}\)). 6. Thyrotoxicose factice : Surdosage accidentel ou intentionnel de lévothyroxine/liothyronine sur ordonnance ou de capsules amaigrissantes non réglementées contenant de la glande thyroïde animale desséchée.

Recognizing the Burch-Wartofsky Point Scale (BWPS) clinical criteria¶

Les médecins urgentistes diagnostiquent cliniquement la tempête thyroïdienne au chevet du patient (sans attendre des heures pour obtenir les résultats du laboratoire d'hormones thyroïdiennes) en utilisant les critères de l'Burch-Wartofsky Point Scale (BWPS) et de la Japan Thyroid Association (JTA). Un patient souffre d’une tempête thyroïdienne potentiellement mortelle lorsque la thyréotoxicose se combine à une décompensation multi-organique dans ces quatre domaines :

1. Échec de la thermorégulation (fièvre \(\ge 38,0^\circ\text{C}\) à \(> 40,0^\circ\text{C}\) [\(100,4^\circ\text{F}\) à \(> 104,0^\circ\text{F}\)]) : Contrairement à une infection normale où une fièvre de 39 \(^\circ\text{C}\) augmente la fréquence cardiaque à environ 100 \(\text{ à }110\text{ bpm}\), lors d'une tempête thyroïdienne, la fréquence cardiaque est extrêmement disproportionnée par rapport à la fièvre, allant souvent de 140\text{ à }190\text{ bpm}$ tandis que la sueur s'écoule de la peau.
2. Dysfonctionnement du système nerveux central (l'indice de diagnostic le plus puissant) : Cela va d'une légère agitation extrême et d'une agitation émotionnelle au délire franc, psychose, confusion extrême, convulsions ou coma. Si un patient a une fréquence cardiaque rapide et de la fièvre plus un état mental altéré, suspectez immédiatement une tempête thyroïdienne.
3. Dysfonctionnement gastro-intestinal et hépatique : Diarrhée aqueuse abondante, nausées et vomissements sévères, douleurs abdominales diffuses et jaunisse inexpliquée (jaunissement du blanc des yeux et de la peau) causée par une hypoxie hépatique congestive et une nécrose des hépatocytes.
4. Cardiovascular Decompensation: Racing sinus tachycardia or rapid atrial fibrillation (\(> 140\text{ bpm}\)) that causes the heart chambers to fill poorly, leading to pulmonary edema (frothy pink sputum, inability to lie flat, crackling lungs) and sudden circulatory shock.

Why hospital treatment of Thyroid Storm must follow a strict 4-step timed order¶

Understanding the hospital sequence helps caregivers advocate for the patient and understand why doctors ask specific questions at triage: 1. Step 1: Block Beta-Adrenergic Receptors (Propranolol, Esmolol, or Landiolol): Given immediately via IV or mouth to slow the racing heart rate below \(100\text{ bpm}\) and prevent fatal arrhythmias. (Critical caveat: If the patient already has severe low-ejection-fraction dilated cardiomyopathy, giving a long-acting beta-blocker like propranolol can cause sudden cardiac arrest; ICU doctors use ultra-short-acting intravenous esmolol or diltiazem backed by bedside ultrasound.) 2. Step 2: Block New Hormone Synthesis (Propylthiouracil [PTU] or Methimazole): Thionamide drugs stop the thyroid peroxidase (TPO) enzyme from making new thyroid hormone; PTU is often favored in the first 24 hours because it also blocks peripheral conversion of inactive \(T_4\) into active \(T_3\) by 40 percent. 3. Step 3: Block Release of Pre-Formed Hormone with Iodine (Lugol's Solution or SSKI), Strictly AT LEAST 1 HOUR AFTER Step 2: High-dose inorganic iodine locks the thyroid gland shut (the Wolff-Chaikoff effect). However, if iodine is given BEFORE the thyroid gland is blocked by PTU or methimazole, the thyroid gland uses that iodine as raw fuel to manufacture a massive new batch of thyroid hormone, pouring gasoline on the thyroid storm. 4. Étape 4 : Bloquer la conversion de \(T_4\) en \(T_3\) et protéger les surrénales avec de l'hydrocortisone IV (100 \(\text{ mg}\) IV toutes les 8 heures) : Parce que la tempête thyroïdienne brûle le cortisol naturel du corps plus rapidement que les glandes surrénales ne peuvent le produire (provoquant une insuffisance surrénalienne relative) et parce que les stéroïdes bloquent la conversion périphérique de \(T_4\en T_3\), chaque patient atteint d'une tempête thyroïdienne reçoit corticostéroïdes intraveineux à dose de stress.

Tableau de référence clinique de l'échelle de points Burch-Wartofsky (BWPS) au chevet¶

Emergency physicians use the Burch-Wartofsky Point Scale to calculate the probability of thyroid storm at the bedside. A total score of 45 points or higher strongly indicates active thyroid storm, 25 to 44 points indicates impending thyroid storm, and below 25 points makes thyroid storm unlikely:

Part 2: Deep dive into Myxedema Coma (Decompensated Hypothyroidism)¶

Despite its name, a patient in "myxedema coma" does NOT have to be completely comatose to be in mortal danger. Most patients present first with severe lethargy, confusion, disorientation, slowed speech, and hypothermia; waiting until they are completely unresponsive before calling 911 / 112 / 999 delays life-saving care.

Common triggers that push chronic hypothyroidism into Myxedema Coma¶

Le coma myxœdème frappe presque toujours un patient plus âgé (80 % sont des femmes de plus de 60 ans) souffrant d'hypothyroïdie de longue date (ou d'une cicatrice au cou oubliée suite à une opération de la thyroïde des décennies plus tôt) qui manque ou arrête de prendre ses comprimés quotidiens de lévothyroxine et rencontre ensuite un deuxième facteur de stress physiologique : - Exposition au froid hivernal (ou vivre dans une maison non chauffée pendant l'hiver). - Taking sedative, opioid, or tranquilizer medications: Because a hypothyroid liver metabolizes drugs at a fraction of normal speed, a single standard tablet of an opioid painkiller (morphine, oxycodone, tramadol), benzodiazepine sleeping pill, sedative antihistamine, antidepressant, or general anesthetic can stay in the bloodstream for days and precipitate full-blown myxedema coma. - Infection aiguë (pneumonie, urosepsie, cellulite ou grippe). - Médicaments qui désactivent directement la glande thyroïde : - Amiodarone (provoque une hypothyroïdie chez 15 à 20 % des patients via une surcharge en iode). - Lithium (se concentre à l'intérieur de la glande thyroïde et bloque la libération d'hormones). - Inhibiteurs du point de contrôle immunitaire contre le cancer (pembrolizumab, nivolumab, ipilimumab : provoquent une destruction auto-immune de la thyroïde et de l'hypophyse) et inhibiteurs de la tyrosine kinase (sunitinib).

Les 5 mécanismes potentiellement mortels du myxœdème coma¶

1. Échec de la commande respiratoire cérébrale (narcose hypercapnique) : Dans le coma myxœdème, le centre respiratoire du tronc cérébral perd sa sensibilité à la fois à un faible taux d'oxygène (hypoxie) et à un taux élevé de dioxyde de carbone (hypercapnie). Combiné à des muscles du diaphragme faibles et à une langue/larynx enflés (macroglossie myxœdémateuse et œdème laryngé), le patient prend des respirations lentes et superficielles, retenant \(\text{CO}_2\) jusqu'à ce qu'il sombre dans le coma de dioxyde de carbone et arrête respiratoire.
2. Profound Non-Shivering Hypothermia: Without thyroid hormone to generate cellular heat (ATP thermogenesis), core body temperature plummets to \(30.0^\circ\text{C}\text{ to }35.5^\circ\text{C}\) (\(86.0^\circ\text{F}\text{ to }95.9^\circ\text{F}\)). Standard home digital thermometers often read "LO" because they cannot measure below \(34.0^\circ\text{C}\) (\(93.2^\circ\text{F}\)). In addition, if a myxedema coma patient has a violent bacterial infection like pneumonia or sepsis, they often cannot mount a fever at all, presenting with a "normal" temperature of \(36.5^\circ\text{C}\) (\(97.7^\circ\text{F}\)) that hides lethal sepsis.
3. Why Active External Heating Causes Fatal Shock: Because cardiac output is severely depressed in myxedema coma, the body survives by clamping down all peripheral skin arteries (intense alpha-adrenergic vasoconstriction). If well-meaning caregivers place a heating pad, electric blanket, or hot water bottles on the cold skin, the skin capillaries dilate abruptly. Blood pools in the skin, central blood pressure drops to zero, and the patient suffers irreversible vasodilatory shock and cardiac arrest.
4. Severe Hyponatremia (Low Blood Sodium) and Hypoglycemia: Reduced kidney water clearance and excess antidiuretic hormone (ADH) dilute blood sodium below \(115\text{ to }125\text{ mmol/L}\), causing brain swelling and seizures, while impaired gluconeogenesis causes severe hypoglycemia.
5. The Cortisol-Before-Thyroid Rule (Preventing Iatrogenic Adrenal Crisis): Up to 10 percent of patients in myxedema coma also have hidden adrenal insufficiency (either autoimmune Addison's disease [Schmidt syndrome / Polyglandular Autoimmune Syndrome Type 2] or pituitary failure). Even in patients with intact adrenal glands, their sluggish adrenal cortex cannot keep up if metabolism is suddenly restarted. Hospital Rule: Doctors must administer intravenous hydrocortisone (\(100\text{ mg}\) IV) BEFORE or simultaneously with intravenous levothyroxine (\(T_4\)); giving thyroid hormone first accelerates liver clearance of the patient's last drops of cortisol and triggers an immediate, fatal adrenal crisis.

Premiers secours étape par étape et soins préhospitaliers en attendant les secours médicaux d'urgence¶

Protocol A: Immediate care for Suspected Thyroid Storm¶

• Step 1: Position for heart and lung relief: If the patient is awake, breathless, or coughing up frothy sputum (signs of acute high-output heart failure and pulmonary edema), sit them upright at a 45- to 90-degree angle with their legs dangling down to reduce fluid return to the congested lungs. If they become dizzy/faint from low blood pressure or unconscious, place them flat or on their side in the recovery position.
• Step 2: Aggressive safe cooling: Remove blankets and excess clothes. Wipe the neck, chest, arms, and legs with lukewarm-to-cool wet washcloths and run an electric fan across the damp skin to maximize evaporative heat loss. Place cloth-wrapped ice packs in the armpits, groin, and sides of the neck.
• Step 3: Medication safety check: Never give aspirin or Pepto-Bismol. Do not give extra unprescribed doses of the patient's daily beta-blocker (such as metoprolol or propranolol) if they are already showing signs of severe heart failure, wheezing, or falling blood pressure; wait minutes for paramedics to attach an ECG monitor.
• Step 4: Protect from injury during delirium: Patients in thyroid storm can experience sudden thyrotoxic psychosis or severe agitation. Clear sharp objects away, dim room lights, turn off loud televisions, and speak calmly without physically wrestling or pinning the patient down (which spikes adrenaline and core temperature further).

Protocol B: Immediate care for Suspected Myxedema Coma¶

• Step 1: Airway protection and jaw support: Because the tongue is thick and swollen (macroglossia) and throat tissues are boggy with mucopolysaccharide fluid, lying flat on the back causes the tongue to seal off the windpipe immediately. Roll the patient gently onto their side into the recovery position and tilt the chin slightly forward to keep the airway open.
• Step 2: Passive external rewarming only: Cover the patient's torso, arms, and legs with 2 to 3 dry indoor blankets, put a warm hat on their head, and place a blanket underneath them if they are on a cold floor. Remove any hot water bottles, heating pads, or electric blankets immediately.
• Step 3: Check for neck scars and medical alert jewelry: Gently inspect the base of the front of the neck (just above the collarbone notch) for a thin horizontal thyroidectomy scar, which is often the only clue in an unconscious older adult living alone that they have no thyroid gland and are in myxedema coma.
• Step 4: Keep Nothing by Mouth (NPO): Because swallowing reflexes are paralyzed and the intestines are often in paralytic ileus, never try to force a drowsy patient in myxedema coma to swallow their missed levothyroxine pill or drink water; hospital doctors must give intravenous levothyroxine and intravenous hydrocortisone.

Script de communication exact pour le 911/112/999 et le triage à l'hôpital¶

Use these clear clinical scripts so dispatchers and emergency physicians recognize the endocrine crisis immediately rather than misdiagnosing it as simple sepsis, stroke, or dementia:

• For Suspected Thyroid Storm:

  "I need an emergency ambulance at [Exact Address]. The patient is a [Age]-year-old [male/female] with [Graves' disease / hyperthyroidism / a neck goiter] who has a high fever of [Temp], a racing heart rate over [140+ bpm], and acute [delirium / agitation / vomiting and diarrhea / shortness of breath]. We suspect life-threatening Thyroid Storm. We are cooling [him/her] externally and have NOT given any aspirin."

• For Suspected Myxedema Coma:

  "I need an emergency ambulance at [Exact Address]. The patient is a [Age]-year-old [male/female] with [hypothyroidism / a thyroidectomy neck scar / missed levothyroxine] who is severely confused and stuporous, ice-cold to the touch with a temperature of [Temp / 'LO'], a slow heart rate under [50 bpm], and slow shallow breathing. We suspect Myxedema Coma. We have [him/her] in the recovery position wrapped in dry blankets with no active heating pads."

Questions fréquemment posées¶

Why can you not give aspirin to bring down the high fever during a thyroid storm?¶

In the bloodstream, over 99 percent of thyroid hormone (T4 and T3) is attached to carrier proteins where it stays inactive, leaving less than 1 percent "free" and active. Aspirin (acetylsalicylic acid) and other salicylates chemically knock thyroid hormone off those carrier proteins, instantly doubling or tripling the level of active free thyroid hormone in the blood and worsening the life-threatening thyroid storm; always use external cooling and acetaminophen (paracetamol) instead.

Why is it dangerous to put an electric heating blanket or hot water bottle on someone in myxedema coma who is freezing cold?¶

A person in myxedema coma has a very weak, slow heart and low blood volume, and their body is only keeping blood pressure up by tightly constricting all the blood vessels in their skin. Putting an electric blanket, heating pad, or hot water bottle on their skin forces those surface blood vessels to open up (vasodilate) all at once, draining blood away from the heart and brain and causing sudden, irreversible shock and cardiac arrest; always use passive rewarming with dry blankets in a warm room.

Why do hospital doctors give intravenous hydrocortisone (a steroid) before giving thyroid hormone in myxedema coma?¶

Up to 10 percent of patients with autoimmune hypothyroidism also have hidden adrenal insufficiency (Addison's disease or pituitary failure), and even patients with normal adrenal glands have sluggish cortisol production during myxedema coma. If a doctor gives intravenous thyroid hormone (levothyroxine) first, the sudden jump in metabolism burns up the body's remaining trace of cortisol within hours, triggering a fatal adrenal crisis; giving 100 milligrams of intravenous hydrocortisone first protects the patient's blood pressure and heart.

Can a common heart medication like amiodarone trigger either thyroid storm or myxedema coma?¶

Yes, amiodarone (a widely prescribed anti-arrhythmic heart medication) is 37 percent iodine by weight and releases roughly 500 times the normal daily human requirement of iodine into the bloodstream every single day. Depending on the patient's underlying thyroid gland, amiodarone can either overload the thyroid to cause severe Amiodarone-Induced Thyrotoxicosis (leading to thyroid storm) or shut down the thyroid gland to cause severe hypothyroidism and myxedema coma, even months after stopping the drug.

Sources vérifiées¶

• American Thyroid Association (ATA, United States) and American Association of Clinical Endocrinology (AACE): Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (Ross et al., Thyroid) and Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (Jonklaas et al., Thyroid, including myxedema coma ICU protocols).
• Japan Thyroid Association (JTA) et Japan Endocrine Society (JES) : Directives pour la gestion de la tempête thyroïdienne (Satoh et al., Endocrine Journal, critères de diagnostic, sélection des bêtabloquants et stratification du risque de mortalité).
• Association européenne de la thyroïde (ETA) et Society for Endocrinology (Royaume-Uni) : Society for Endocrinology Endocrine Emergency Guidance : Gestion d'urgence de la tempête thyroïdienne et de la crise du myxœdème (hypothyroïdie décompensée) chez les patients adultes (Connexions endocriniennes).
• Institut national pour l'excellence en matière de santé et de soins (NICE, Royaume-Uni) : Maladie thyroïdienne : évaluation et gestion (ligne directrice NICE NG145).
• Burch HB, Wartofsky L : Thyrotoxicose potentiellement mortelle : tempête thyroïdienne (Cliniques d'endocrinologie et de métabolisme d'Amérique du Nord, système de notation diagnostique fondamental de l'échelle de points Burch-Wartofsky [BWPS]).

Guides associés¶

• Crise surrénalienne et injection d'urgence d'hydrocortisone
• Premiers secours en cas d'hypothermie et d'engelures
• Coup de chaleur ou épuisement dû à la chaleur ? Refroidissement d'urgence
• Reconnaissance des chocs et gestion des premiers secours
• Reconnaissance du sepsis et du choc septique