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Critical Care
Published in: Critical Care 1/2020

01-12-2020 | Insulins | Research

Early administration of glucocorticoid for thyroid storm: analysis of a national administrative database

Authors: Atsushi Senda, Akira Endo, Hisateru Tachimori, Kiyohide Fushimi, Yasuhiro Otomo

Published in: Critical Care | Issue 1/2020

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Abstract

Background

Thyroid storm is a life-threatening disease with a mortality rate of over 10%. Although glucocorticoids have been recommended as a treatment option for thyroid storm, supportive evidence based on a large-scale clinical research is lacking. The objective of the current study was to evaluate the beneficial effects of glucocorticoids in the treatment of patients with severe thyroid storm.

Methods

A retrospective nationwide cohort study was conducted using a Japanese national administrative claims database. Patients admitted to intensive care units due to severe thyroid storm between the financial years 2013 and 2017 were included in the study. The primary outcome was in-hospital mortality; secondary outcomes were mortality within 30 days and insulin administration during hospitalization. Generalized linear mixed model (GLMM) with maximum likelihood estimation (MLE) and Bayesian estimation using Markov chain Monte Carlo methods (MCMC), in addition to propensity score matching (PSM), were used for statistical analysis.

Results

A total of 811 patients were included in the study, of which 600 patients were treated with glucocorticoids, and 211 patients were treated without glucocorticoids. The early administration of glucocorticoids was not associated with a significant improvement in the in-hospital mortality of patients with thyroid storm [adjusted odds ratio (95% confidence interval) = 1.77 (0.95–3.34), 1.44 (1.14–1.93), and 1.46 (0.72–3.00) in the GLMM (MLE), GLMM (MCMC), and PSM, respectively]. The results of mortality within 30 days were almost identical to the results of in-hospital mortality. However, insulin use was significantly higher in the glucocorticoid group.

Conclusions

This analysis of a nationwide administrative database indicates that the administration of glucocorticoids does not improve the survival of patients with thyroid storm.
Appendix
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Metadata
Title
Early administration of glucocorticoid for thyroid storm: analysis of a national administrative database
Authors
Atsushi Senda
Akira Endo
Hisateru Tachimori
Kiyohide Fushimi
Yasuhiro Otomo
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-03188-8

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