Thyroid storm: Both beta-1 selective beta-blockers and propranolol fail to improve in-hospital mortality, study finds

To fill this knowledge gap, the retrospective cohort study by Yuichiro Matsuo, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan, and colleagues aimed to investigate the in-hospital mortality of patients with thyroid storms based on the choice of beta-blockers.

The study used the diagnosis procedure combination database, a national inpatient database in Japan, and included patients hospitalized with thyroid storm between April 2010 and March 2022.

Propensity-score overlap weighting was performed to compare in-hospital mortality between patients who received beta-1 selective beta-blockers versus those who received propranolol. Subgroup analysis was also conducted, considering the absence or presence of acute heart failure.

Among the 2462 eligible patients, 1452 received beta-1 selective beta-blockers, and 1010 received propranolol.

Based on the study, the researchers reported the following findings:

• The crude in-hospital mortality rates were 9.3% for the beta-1 selective beta-blocker group and 6.2% for the propranolol group.
• After adjusting for baseline variables, the use of beta-1 selective beta-blockers was not associated with lower in-hospital mortality (6.3% vs. 7.4%; odds ratio, 0.85).
• No significant difference in in-hospital mortality was observed in patients with acute heart failure.

Further research is warranted to validate these findings and elucidate the underlying mechanisms behind the differential efficacy of beta-blockers in thyroid storms, including prospective randomized controlled trials.

"Nonetheless, the present study represents a critical step forward in optimizing the management of this life-threatening endocrine emergency, ultimately improving patient outcomes and reducing mortality rates," the researchers concluded.

Reference:

Matsuo, Yuichiro MD, MPH1; Jo, Taisuke MD, PhD2; Watanabe, Hideaki MD, MPH1; Matsui, Hiroki MPH1; Fushimi, Kiyohide MD, PhD3; Yasunaga, Hideo MD, PhD1. Clinical Efficacy of Beta-1 Selective Beta-Blockers Versus Propranolol in Patients With Thyroid Storm: A Retrospective Cohort Study. Critical Care Medicine ():10.1097/CCM.0000000000006285, March 29, 2024. | DOI: 10.1097/CCM.0000000000006285