Thyroid Storm
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Contents |
Introduction
- Life-threatening complication of hyperthyroidism.
Etiology
- precipitating factors
- infection (most common)
- surgical stress or anesthesia
- sudden withdrawal of thionamide ( PTU, methimazole)
- large doses of I-[131] given to severely thyrotoxic patient with large goiter
- generally occurs within 7-10 days post therapy
- untreated Graves disease
Pathology
- acute release of preformed hormone
- no correlation between level of circulating level of T4 & severity of symptoms
Clinical-manifestations
- acutely ill patient with exacerbated symptoms of hyperthyroidism
- fever > 100 degrees F
- tachycardia > 120/min, atrial fibrillation, heart failure
- hypotension
- abdominal pain, nausea, vomiting
- jaundice
- diarrhea
- delirium, psychosis
- seizures, apathy, stupor & coma as condition worsens
- elderly patients may lack hyperkinetic features & present with lethargy & cardiac manifestations only
- patients on beta blockers may have blunted manifestations
Laboratory
- see hyperthyroidism
- increased free T4, free T3
- abnormal liver function tests
Management
- propranolol
- propylthiouracil ( methimazole does not do this)
- dexamethasone (4-8 mg/day)
- decrease release of thyroid hormone
- saturated solution of KI ( SSKI): 5-10 drops in water
- Lugol's solution: 5-10 drops
- 1 g NaI IV over 8-10 hours
- treat associated adrenal dysfunction
- treat associated thermoregulatory dysfunction
- cooling blanklets
- acetamionphen
- treat precipitating factors
- reverse systemic decompensation
- poor outcome is associated with:
- circulatory collapse
- obtundation
- jaundice (in absence of CHF)
More General Terms
References
- Contributions from Paulette Ginier Dept of Endocrinology, UCSF Fresno
- Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, American College of Physicians, Philadelphia 1998, 2006, 2009
