Thyroid storm, also known as thyrotoxic crisis, is a rare but life-threatening condition characterized by severe hypermetabolism due to excessive release of thyroid hormones. This nursing diagnosis requires immediate recognition and intervention as it can be fatal if not treated promptly.
Causes (Related to)
Thyroid storm can develop from various conditions that trigger an excessive release of thyroid hormones. Common causes include:
- Untreated or poorly managed hyperthyroidism
- Stress triggers such as:
- Surgery
- Trauma
- Infection
- Pregnancy/labor
- Diabetic ketoacidosis
- Medication-related causes including:
- Sudden discontinuation of antithyroid medications
- Excessive iodine intake
- Radioactive iodine therapy
- Other medical conditions such as:
- Severe emotional stress
- Myocardial infarction
- Pulmonary embolism
- Cerebrovascular accident
Signs and Symptoms (As evidenced by)
Thyroid storm presents with severe manifestations of hyperthyroidism. Patients may exhibit the following:
Subjective: (Patient reports)
- Extreme anxiety
- Restlessness
- Heat intolerance
- Palpitations
- Tremors
- Severe fatigue
- Muscle weakness
- Shortness of breath
Objective: (Nurse assesses)
- Hyperthermia (temperature >103°F/39.4°C)
- Tachycardia (heart rate >140 beats/minute)
- Hypertension followed by hypotension
- Cardiac dysrhythmias
- Altered mental status
- Agitation or delirium
- Profuse sweating
- Nausea and vomiting
- Diarrhea
- Jaundice
- Goiter (possible)
- Exophthalmos (in Graves’ disease)
Expected Outcomes
The following are the common nursing care planning goals and expected outcomes for thyroid storm:
- The patient will maintain stable vital signs
- The patient will demonstrate improved mental status
- Patient will maintain adequate hydration
- The patient will show decreased symptoms of thyrotoxicosis
- Patient will verbalize understanding of medication regime
- The patient will demonstrate proper stress management techniques
- Patient will maintain a normal cardiac rhythm
- The patient will maintain a normal body temperature
Nursing Assessment
A thorough nursing assessment is crucial for early recognition and management of thyroid storm.
1. Monitor vital signs frequently
Monitor temperature, heart rate, blood pressure, and respiratory rate every 15-30 minutes until stable. Thyroid storms cause significant alterations in vital signs that require immediate intervention.
2. Assess neurological status
Evaluate the level of consciousness, orientation, and behavior changes. A thyroid storm can cause severe agitation, confusion, and even coma.
3. Perform cardiovascular assessment
Check for:
- Irregular heart rhythms
- Signs of heart failure
- Peripheral perfusion
- Presence of edema
4. Monitor respiratory status
Assess:
- Respiratory rate and pattern
- Use of accessory muscles
- Oxygen saturation
- Presence of dyspnea
5. Assess skin condition
Check for:
- Temperature
- Moisture
- Color
- Texture
- Presence of goiter
6. Monitor fluid balance
Assess:
- Input and output
- Signs of dehydration
- Mucous membrane moisture
- Skin turgor
7. Review laboratory values
Monitor:
- Thyroid function tests (T3, T4, TSH)
- Complete blood count
- Electrolytes
- Liver function tests
- Cardiac enzymes
Nursing Care Plans
Care Plan #1: Hyperthermia
Nursing Diagnosis Statement:
Hyperthermia related to hypermetabolic state secondary to thyroid storm as evidenced by temperature >103°F, profuse sweating, and tachycardia.
Related Factors:
- Increased metabolic rate
- Excessive thyroid hormone production
- Autonomic nervous system dysfunction
Nursing Interventions and Rationales:
- Monitor temperature every 15-30 minutes
Rationale: Allows for early detection of dangerous temperature elevations - Apply cooling measures (ice packs, cooling blanket)
Rationale: Helps reduce body temperature and prevent complications - Administer antipyretics as ordered
Rationale: Helps reduce fever and associated discomfort - Monitor for signs of shivering
Rationale: Shivering can increase metabolic rate and worsen the condition
Desired Outcomes:
- The patient will maintain a body temperature between 97.8°F and 99°F
- The patient will demonstrate stable vital signs
- The patient will report an improved comfort level
Care Plan #2: Decreased Cardiac Output
Nursing Diagnosis Statement:
Decreased Cardiac Output related to hypermetabolic state secondary to thyroid storm as evidenced by tachycardia, dysrhythmias, and hypotension.
Related Factors:
- Increased heart rate and contractility
- Peripheral vasodilation
- Fluid volume deficit
Nursing Interventions and Rationales:
- Monitor cardiac rhythm continuously
Rationale: Allows for early detection of life-threatening arrhythmias - Administer beta-blockers as ordered
Rationale: Helps control heart rate and reduce cardiac workload - Position patient semi-Fowler’s
Rationale: Optimizes cardiac output and reduces workload
Desired Outcomes:
- The patient will maintain a heart rate <100 beats/minute
- The patient will demonstrate stable blood pressure
- The patient will show no signs of cardiac compromise
Care Plan #3: Deficient Fluid Volume
Nursing Diagnosis Statement:
Deficient Fluid Volume related to a hypermetabolic state and excessive fluid loss as evidenced by dry mucous membranes decreased skin turgor, and concentrated urine.
Related Factors:
- Increased metabolic rate
- Profuse sweating
- Diarrhea and vomiting
- Fever
Nursing Interventions and Rationales:
- Monitor intake and output strictly
Rationale: Helps assess fluid balance status - Administer IV fluids as ordered
Rationale: Replaces fluid losses and maintains hydration - Monitor for signs of dehydration
Rationale: Allows for early intervention
Desired Outcomes:
- The patient will maintain adequate hydration
- The patient will demonstrate stable vital signs
- The patient will have moist mucous membranes and good skin turgor
Care Plan #4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to physiological changes and critical illness as evidenced by restlessness, agitation, and expressed feelings of doom.
Related Factors:
- Severe illness
- Physiological changes
- Hospitalization stress
- Fear of death
Nursing Interventions and Rationales:
- Provide a calm, quiet environment
Rationale: Reduces external stimuli and promotes relaxation - Explain all procedures
Rationale: Reduces anxiety and promotes cooperation - Administer anti-anxiety medications as ordered
Rationale: Helps control severe agitation
Desired Outcomes:
- The patient will demonstrate decreased anxiety
- The patient will use effective coping mechanisms
- The patient will verbalize understanding of condition and treatment
Care Plan #5: Ineffective Thermoregulation
Nursing Diagnosis Statement:
Risk for Ineffective Thermoregulation related to excessive thyroid hormone production and metabolic demands.
Related Factors:
- Elevated thyroid hormone levels
- Increased metabolic rate
- Autonomic nervous system dysfunction
Nursing Interventions and Rationales:
- Monitor environmental temperature
Rationale: Helps maintain optimal thermal environment - Implement cooling measures as needed
Rationale: Prevents complications of hyperthermia - Monitor for signs of heat exhaustion
Rationale: Allows for early intervention
Desired Outcomes:
- The patient will maintain a normal body temperature
- The patient will demonstrate stable vital signs
- The patient will show no signs of heat-related complications
References
- Ross, D. S., Burch, H. B., Cooper, D. S., et al. (2023). American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid, 33(1), 142-183.
- Satoh, T., Isozaki, O., Suzuki, A., et al. (2022). Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society. Endocrine Journal, 69(7), 611-633.
- Pokhrel, B., Bhusal, K., & Thapa, S. (2023). Thyroid Storm. In StatPearls. Treasure Island (FL): StatPearls Publishing.
- Herdman, T. H., & Kamitsuru, S. (2024). NANDA International Nursing Diagnoses: Definitions & Classification 2024-2026. Thieme.
- Bulechek, G. M., Butcher, H. K., Dochterman, J. M., & Wagner, C. M. (2023). Nursing Interventions Classification (NIC), 8th Edition. Elsevier.
- Swearingen, P. L. (2023). All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health, 6th Edition. Elsevier.
