{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T01:27:08Z","timestamp":1793237228763,"version":"4.5.0"},"reference-count":19,"publisher":"The Endocrine Society","issue":"5","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Thyroid storm is a life-threatening endocrine emergency. Although predictors of mortality have been described, determinants of diagnostic delay remain unclear. We aimed to identify factors associated with diagnostic delay in thyroid storm and its relationship with severe clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of adults admitted with thyroid storm at a tertiary-care hospital over 12 years. The primary endpoint was time from symptom onset to diagnosis (days). Factors associated with time to diagnosis were evaluated using multivariable linear regression adjusting for predefined covariates, including age, initial onset vs recurrence, admitting department, presenting symptoms, and cardiac rhythm abnormalities. Secondary analyses examined delayed diagnosis (\u22657 days) using multivariable logistic regression. Additional analyses separated diagnostic delay into patient-related and in-hospital components and evaluated admission pathways and referral status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ninety-one patients were included. Median time to diagnosis was 5 days (interquartile range 3.5-7). Older age (1.08 days per 10-year increase; P &amp;lt; .001), initial onset (4.10 days; P &amp;lt; .001), and admission to non-emergency departments (2.76 days; P = .004) were independently associated with longer diagnostic delay, whereas symptom patterns and thyroid hormone levels were not. Patient-related delay did not differ by admission pathway, but in-hospital delay was longer among non-emergency admissions. Delayed diagnosis was associated with increased need for intensive care and organ support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Diagnostic delay in thyroid storm appears driven mainly by clinical pathways rather than symptom patterns or biochemical severity. Earlier consideration of thyroid storm and prompt thyroid testing\u2014particularly at initial onset and in non-emergency settings\u2014may improve outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/jendso\/bvag088","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T11:51:05Z","timestamp":1775217065000},"source":"Crossref","is-referenced-by-count":2,"title":["Determinants of diagnostic delay in thyroid storm: a 12-year single-center cohort study"],"prefix":"10.1210","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1268-4871","authenticated-orcid":false,"given":"Tetsuya","family":"Kawahara","sequence":"first","affiliation":[{"name":"Division of Endocrinology and Metabolism, Shinkomonji Hospital , Kitakyushu, Fukuoka 800-0057 ,","place":["Japan"]},{"name":"Department of Internal Medicine, University of Occupational and Environmental Health , Kitakyushu, Fukuoka 525-0058 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikio","family":"Toda","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Shinkomonji Hospital , Kitakyushu, Fukuoka 800-0057 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maiko","family":"Kanagawa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Shinkomonji Hospital , Kitakyushu, Fukuoka 800-0057 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nagahiro","family":"Toyama","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Shinkomonji Hospital , Kitakyushu, Fukuoka 800-0057 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chie","family":"Kawahara","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Occupational and Environmental Health , Kitakyushu, Fukuoka 525-0058 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Inazu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, College of Pharmaceutical Science, Ritsumeikan University , Kusatsu, Shiga 525-8577 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"issue":"11","key":"2026050513462502300_bvag088-B1","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1089\/thy.2022.0096","article-title":"Estimating incidence and case fatality of thyroid storm in Germany between 2007 and 2017: a claims data analysis","volume":"32","author":"Thiyagarajan","year":"2022","journal-title":"Thyroid"},{"issue":"1","key":"2026050513462502300_bvag088-B2","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1089\/thy.2018.0275","article-title":"National trends in incidence, mortality, and clinical outcomes of patients 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Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition)","volume":"63","author":"Satoh","year":"2016","journal-title":"Endocr J"},{"issue":"1","key":"2026050513462502300_bvag088-B6","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s00134-014-3545-8","article-title":"Understanding the HPA response to critical illness: novel insights with clinical implications","volume":"41","author":"Boonen","year":"2015","journal-title":"Intensive Care Med"},{"issue":"4","key":"2026050513462502300_bvag088-B7","doi-asserted-by":"crossref","first-page":"109565","DOI":"10.5492\/wjccm.v14.i4.109565","article-title":"Thyroid storm-induced cardiovascular complications and modalities of therapy: up-to-date review","volume":"14","author":"El-Menyar","year":"2025","journal-title":"World J Crit Care 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