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Hi again so this will be a very brief talk on thyroid storm which is a rare but life-threatening form of thyrotoxicosis is a complication of any disease that causes hyperthyroidism so the symptoms are going to be of course hyper thyroid symptoms or a history of hyper thyroid symptoms such as heat intolerance sweating palpitations nausea vomiting diarrhea weight
Loss and increased appetite a lot of times though the patient will not be able to tell you that because in addition to these symptoms they’re going to have altered mental status that could manifest in delirium seizures coma they can have hypertension early on hypotension is a late manifestation of the disease generally they’re going to be febrile and they may even
Be in shock so what’s going to be most important to gather from these patients that you’re considering thyroid storm is that they have a history of hyperthyroidism a history of graves disease so what separates thyroid storm apart from just regular old hyperthyroidism thyrotoxicosis is that the patient has altered mental status and vital instability the patient
Is hypotensive the patient is delirious the patient is seizing that’s going to separate it from just regular old hyperthyroidism now anytime you have a patient with a history of graves disease of history of thyroid disease or even say a depressed patient that has that has levothyroxine pills available or a child that got into a bottle of levothyroxine pills then
You’re going to suspect thyroid storm so the diagnosis the best first step is going to be a tsh level and the tsh level is generally going to be low and your t3 and t4 levels are always going to be high so as always you should remember your abcs so if there’s shock you should be the first step is to administer fluids and the treatment for the thyroid storm the
Best initial step is going to be iv propa thyatira so teaching you and you’re going to use pt you instead of methimazole because pt you works quicker and luckily pt you is not contraindicated in pregnant women so we can use it in them as well we should also give iodine iodine acutely stops the release of hormone so something like lugol’s solution or potassium
Iodide can be used and that will acutely stop hormone release from the thyroid you should treat their symptoms with an anti adrenergic such as propranolol propranolol is generally the drug of choice and then iv dexamethasone is also given to decrease peripheral conversion of t4 to t3 but remember that the best initial step in the treatment of a patient where you
Suspect thyroid storm is iv ptu and you really can’t go wrong because if you have if you have altered mental status and you have high t3 and high t4 that’s really really indicative of thyroid storm and iv ptu is our pt you in general is going to be indicated in patients with graves disease so that’s generally a safe choice you should also be providing supportive
Measures and that can be like cooling blankets patients should have iv fluids going remember if they have shock of course that’s going to be your your first first step but they should have iv fluids going anyways you may have electrolyte abnormalities so you’ll want to control that as needed dextrose should be given in the case of hypoglycemia you can use like a
D50 amp would be fine for that you should always admit these patients to the icu and work up for underlying cause should be undertaken so pan cultures like urinalysis blood cultures so forth chest x-ray and then at discharge you should switch these patients off to methimazole unless it’s contraindicated just because of the safety profile of methimazole is a little
Better than pt you remember though the patient’s you’re not going to use methimazole in is children and pregnant women radioactive iodine ablation should or subtotal thyroidectomy is going to be indicated in all patients who’ve been diagnosed with thyroid storm and remember that radioactive iodine ablation is the test of is the treatment of choice however subtotal
Thyroidectomy would be indicated again in children and in pregnant women and that’s pretty much it for thyroid storm
Transcribed from video
Thyroid Storm – CRASH! Medical Review Series By Paul Bolin M.D.
