Management of Thyroid Emergencies: Joint Consensus Statement on Management of Thyroid Storm

Abstract

Thyroid storm is a rare but life-threatening endocrine emergency characterized by extreme thyrotoxicosis and multi-organ dysfunction. Prompt recognition and rapid, coordinated management are essential to reduce its high mortality. This consensus statement, developed by experts in endocrinology and acute care, provides practical recommendations for the diagnosis and treatment of thyroid storm. Diagnosis remains clinical, aided by validated scoring systems such as the Burch–Wartofsky and Japanese Thyroid Association/Japan Endocrine Society criteria, which also predict outcomes. Management requires a multidisciplinary approach in high-dependency or intensive care settings, incorporating supportive measures, aggressive treatment of precipitating factors, and targeted therapies. Core treatments include beta-blockade, high-dose antithyroid drugs, corticosteroids, and iodide, with careful attention to timing and contraindications. Adjunctive therapies such as cholestyramine, lithium, plasmapheresis and extracorporeal membrane oxygenation (ECMO), as well as surgical thyroidectomy in selected cases, may be required for refractory disease. This guidance also highlights the need for definitive management of underlying hyperthyroidism after stabilization. By summarizing current evidence and expert consensus, this document aims to standardize care, support clinical decision-making, and improve outcomes in patients presenting with thyroid storm.