Thyrotoxic crisis or Thyroid storm

Thyrotoxic crisis or thyroid storm

  • It is a life-threatening hyperthyroidism with fever, seizures, coma, vomiting, diarrhoea, jaundice.
  • A rare but often life-threatening medical emergency resulting from untreated hyperthyroidism
  • Death can occur due to cardiac failure, arrhythmias, hyperthermia.

Thyrotoxic crisis or Thyroid storm

Thyrotoxic crisis or Thyroid storm


Thyrotoxic crisis Symptoms include : —

  • and fingernails may separate from the nail bed (Plummer’s nails).
  • Cardiovascular findings include tachycardia, systolic hypertension, systolic murmur, and atrial fibrillation.
  • excessive sweating,
  • Eyelid retraction and lid lag may be present.
  • frequent bowel movements, and oligomenorrhea.
  • heat intolerance,
  • irritability,
  • nervousness,
  • palpitations, fatigue and weakness,
  • Pts are anxious, restless, and fidgety.
  • Skin is warm and moist,
  • weight loss with increased appetite,

Thyrotoxic crisis Treatment  : 

  • Treatment of the precipitating causes like infection, stroke, diabetic ketoacidosis.
  • Supportive care
  • A beta-blocker to control the symptoms induced by increased adrenergic tone.
  • An iodine solution to block the release of thyroid hormone.
  • An iodinated radiocontrast agent (if available) to inhibit the peripheral conversion of T4 to T3.
  • Glucocorticoids to reduce T4-to-T3 conversion and possibly treat the autoimmune process in Graves’ disease.
  • Radioiodine therapy
  • Large doses of propyl thiouracil – 600 mg loading and 200 mg 6 hrly
  • A thionamide, such as methimazole, to block new hormone synthesis.
  • Propranolol
  • Corticosteroids – Dexamethasone 2 mg 6 hrly Oxygen, IV fluids, Cooling the body.

Thyrotoxic crisis or Thyroid storm Diagnosis Criteria :

Thermoregulatory dysfunction

Temperature

99-99.9 5
100-100.9 10
101-101.9 15
102-102.9 20
103-103.9 25
104.0 30

Central nervous system effects

Mild 10
Agitation
Moderate 20
Delirium
Psychosis
Extreme lethargy
Severe 30
Seizure
Coma

Gastrointestinal-hepatic dysfunction

Moderate 10
Diarrhea
Nausea/vomiting
Abdominal pain
Severe 20
Unexplained jaundice

Cardiovascular dysfunction

Tachycardia

99-109 5
110-119 10
120-129 15
130-139 20
140 25

Congestive heart failure

Mild 5
Pedal edema
Moderate 10
Bibasilar rales
Severe 15
Pulmonary edema
Atrial fibrillation 10
Precipitant history
Negative 0
Positive 10
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