Thyroid Storm: From Endocrine Crisis to Cardiovascular Collapse — Pathophysiology, Diagnosis and Contemporary Management

Thyroid storm is a rare but life-threatening endocrine emergency characterized by thyrotoxicosis accompanied by systemic decompensation and end-organ dysfunction. Despite advances in diagnosis and treatment, it remains associated with substantial mortality, cardiovascular failure and multiorgan dysfunction representing major causes of death. This narrative review aims to summarize current knowledge regarding the pathophysiology, clinical presentation, diagnostic approaches, cardiovascular complications, and contemporary treatment strategies for thyroid storm, with particular emphasis on the management of severe cardiovascular manifestations. A narrative literature review was conducted using PubMed and Google Scholar. Recent peer-reviewed studies, systematic reviews, case series, clinical guidelines, and international consensus recommendations were analyzed to provide an up-to-date overview of thyroid storm management. Thyroid storm requires rapid recognition based on clinical manifestations of systemic decompensation in the setting of biochemical thyrotoxicosis. Cardiovascular complications, including tachyarrhythmias, atrial fibrillation, acute heart failure, thyrotoxic cardiomyopathy, myocardial injury, cardiogenic shock, and cardiac arrest, are among the most clinically significant complications. Treatment requires a multimodal approach - antithyroid drugs, iodine, glucocorticoids, β-blockers, and supportive intensive care. Propranolol remains an important therapeutic option; however, β-blockade must be individualized in patients with impaired cardiac function or hemodynamic instability. Alternative and rescue therapies, including lithium, cholestyramine, therapeutic plasma exchange, and thyroidectomy, may be considered in refractory cases. Successful management of thyroid storm requires early diagnosis, prompt treatment, continuous cardiovascular monitoring, and an individualized multidisciplinary approach. Further studies are needed to establish optimal treatment strategies, particularly for patients with cardiovascular complications and those who fail or cannot tolerate conventional therapy.