Thyrotoxicosis and Choledocholithiasis Masquerading as Thyroid Storm

Table 2

Diagnostic criteria of thyroid storm established by the Japan Thyroid Association.

Final criteria for the diagnosis of thyroid storm adapted from Akamizu et al. [2]
Grade of TS	Combinations of features	Requirements for diagnosis
TS1	First combination	Thyrotoxicosis and at least one CNS manifestation, and one of the following: fever, tachycardia, CHF, or GI/hepatic manifestations
TS1	Alternate combination	Thyrotoxicosis and at least three combinations of fever, or tachycardia, or CHF< or GI/hepatic manifestations
TS2	First combination	Thyrotoxicosis and a combination of two of the following: fever or tachycardia or CHF or GI/hepatic manifestations
TS2	Alternate combination	Patients who meet the diagnostic criteria for TS1 except that serum FT3 or FT4 values are not available but whose data before or after the episode suggest that they are thyrotoxic at the time of TS

Definitions. (i) TS1: definite thyroid storm; TS2: suspected thyroid storm; (ii) thyrotoxicosis: elevated FT3 or FT4; (iii) CNS manifestations: restlessness, delirium, mental aberration/psychosis, somnolence/lethargy, convulsion, and coma including a score of 1 or higher on the Japan Coma Scale (JCS) or 14 or lower on the Glasgow Coma Scale (GCS); (iv) fever: 38°C or higher; (v) tachycardia: ≥130 beats/min (arrhythmias such as atrial fibrillation are evaluated by measuring the heart rate); (vi) CHF: the patient presenting with severe symptoms such as pulmonary edema, moist rales for more than half the lung field, or cardiogenic shock. The patient’s CHF is categorized as Class IV by the NYHA classification or Class III or higher by the Killip classification; (vii) GI/hepatic manifestations: the patient presenting with nausea, vomiting, diarrhea, or a bilirubin of >3 mg/dL.