168: Thyroid Storm: When the Body Ramps Up Into Overdrive

One septic patient, heart rate of 164, and blood pressure that doesn’t fit… Let’s break down what really happens during thyroid storm.

Sarah shares the case of a 26-week pregnant woman admitted with urosepsis, who suddenly becomes flushed, sweaty and confused with vital signs that aren’t exactly fitting the sepsis clinical picture. From the clues that show up during the bedside assessment to compounding conditions, she shares how a diagnosis was reached and how multiple teams came together to treat the patient.

You’ll learn why hyperthyroidism can become thyroid storm, the red flags to watch for, and the treatment approach that targets the storm without doing more harm.

Topics discussed in this episode:

• Bedside assessment clues you can’t get from the chart
• Why sinus tachycardia is a symptom, not a diagnosis
• Severe-range blood pressure and preeclampsia in pregnancy
• Thyroid physiology and Graves’ disease
• Common triggers of thyroid storm
• How thyroid storm affects the heart, the metabolic system, and brain
• Diagnosing thyroid storm: labs and the Burch-Wartofsky Point Scale
• Choosing the right beta blocker
• Why iodine timing matters in treatment
• The art of nursing when a diagnosis doesn’t explain everything

The 2026 joint consensus statement on management of thyroid storm, published in the European Thyroid Journal:

https://doi.org/10.1530/ETJ-26-0043

The American Thyroid Association’s 2026 Guidelines for Thyroid Disease in Preconception, Pregnancy, and Postpartum:

https://journals.sagepub.com/doi/10.1177/10507256261445624

ACOG District IV’s review of Hypertensive Disorders of Pregnancy:

https://www.acog.org/community/districts-and-sections/district-iv/whats-new/countdown-to-intern-year-week-3-hypertensive-disorders

Mentioned in this episode:

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