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 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 |
|
