Thyroid Storm
Definition
Thyroid storm/thyrotoxic crisis is form of severe hyperthyroidism
Abrupt in onset
If not treated fatal
The pateint becomes critically ill.
Aetiology
Precipitated by stress such as injury, infection, thyrois and non thyrois surgery, tooth extraction, insulin reaction, diabetic acidosis, pregnance, digitalis intoxication
Abrupt withdrawal of antithyrois medication
Extreme emotional stress
Vigorous palpation of the thyroid
All these in a partially controlled or completely untreated patient with hyperthyroidism
Clinical Manifestations
High fever (Hyperpyrexia) above 38.5° (101.3°F)
Extreme tachycardia > 130/min
Exageerated symptoms of hyperthyroidism with disturbances of a major system :
GIT - weight loss, diarrhea, abdominal pain
CVS - edema, chest pain, dyspnea, palpitations
Altered neurologic or mental state - delirium, psychosis, somnolence or coma
Management
Hypothermia mattress or blanket, ice packs, cool environment, hydrocortisone and acetaminophen to reduce body temperature.
Aspirin displaces displace thyroid hormone from binding proteins and therefore not used.
Humidified O2 to meet high metabolic demands
Monitor with pulse oxymetry and ABG (arterial blood gas analysia)
IV fluids containing dextrose
PTU or methimazole
Hydrocortisone for shock or adrenal insufficiency
Iodine to decrease output of T4
For CVS problems Propranalol combines with digitalis
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