BACKGROUND
Thyroid Storm is the most severe form of hyperthyroidism. It causes severe symptoms and potentially failure of kidneys, liver and other organs. It can be life-threatening, with a death rate between 8-25%. Thyroid Storm occurs mostly in people who already have a diagnosis of hyperthyroidism such Graves disease. It occurs usually when these individuals experience stress due to surgery, infections, injuries, or take medications containing iodine. Because these situations frequently occur in hospitals, it is crucial to identify and prepare for patients at high risk of developing thyroid storm. Moreover, treating thyroid storm is a difficult task even for experienced doctors. While several scoring systems measure the severity of thyroid storm have been developed to help diagnose thyroid storm, there is still no unanimous agreement on the criteria. So far, only 3 research studies have looked into the epidemiology of thyroid storm, and they estimate an incidence of 0.20 to 0.76 cases per 100,000 people per year. The condition seems to be more common in females and in individuals who are older than 40.

To learn more about this condition and how it affects different populations, this study was conducted using a large database of medical claims from Germany to estimate how often thyroid storm occurs and the likelihood of survival for those who experience it.

THE FULL ARTICLE TITLE
Thiyagarajan A et al Estimating Incidence and Case Fatality of Thyroid Storm in Germany Between 2007 and 2017: A Claims Data Analysis. Thyroid. 2022 Nov;32(11):1307-1315. doi: 10.1089/thy.2022.0096. Epub 2022 Sep 28. PMID: 36006371.

SUMMARY OF THE STUDY
The researchers examined a large database called the German Pharmacoepidemiological Research Database (GePaRD) and identified 1690 patients who were diagnosed with thyroid storm between 2007 and 2017. They then calculated age-standardized rates of thyroid storm in both males and females. They also calculated the number of patients who died within 30 days after being diagnosed with a thyroid storm.

Out of all the patients with thyroid storm, 72% were female, and on average, they were 60 years old. The estimated occurrence of thyroid storm was 1.4 cases per 100,000 people per year in females and 0.7 cases per 100,000 people per year in males. Interestingly, the rate of thyroid storm was much higher in both females (2.7 cases per 100,000 per year) and males (1.7 cases per 100,000 per year) who were older than 60 years. Females and males less than 60 years had relatively low death rate from thyroid storm, only 1.4% and 1.0% respectively, whereas in those over 60 years, the situation was more serious. The death rate for females in this age group was 10.9%, and for males, it was even higher at 16.7%.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This is the first study reporting population-based data on diagnosis and death rate of thyroid storm in Germany. The findings suggest that every year there was about one case of thyroid storm per 100,000 persons. However, the diagnosis rate strongly varies with age and sex since the rate of thyroid storm was two times higher in females than in males and it was 3 times higher in persons >60 years compared with younger individuals. While the death rate is lower then 1.5% in people ≤60 years of age, it is 17 times higher in males and 8 times higher in females over 60 years. Thus it is inportant that doctors become more aware and skilled at diagnosing thyroid storm, especially in a hospital setting. This way, they can start treatment as soon as possible.

— Philip Segal, MD

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