Which feature best distinguishes thyroid storm from uncomplicated thyrotoxicosis?
- A Presence of fever with marked tachycardia out of proportion to the hormone levels, plus CNS dysfunction such as delirium ✓
- B Suppressed TSH with elevated free T4
- C Diffuse goitre with positive TRAb antibodies
- D Fine tremor and weight loss despite increased appetite
Correct answer: A. Presence of fever with marked tachycardia out of proportion to the hormone levels, plus CNS dysfunction such as delirium
Explanation
Thyroid storm is a clinical diagnosis made with scoring systems such as Burch-Wartofsky; its defining elements are hyperpyrexia, disproportionate cardiovascular derangement, and central nervous system involvement including agitation or delirium. Hormone levels overlap with ordinary thyrotoxicosis and do not distinguish severity, which kills option B. Diffuse goitre and TRAb positivity occur in both conditions, and tremor with weight loss is routine thyrotoxicosis.
Reference: Williams Textbook of Endocrinology, 14th ed.
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