406 E3 - thyroid crisis

Question 1

thyrotoxic crisis

Answer 1

a rare, life threatening condition most commonly precipitated by surgery, trauma or infection which causes an overwhelming release of thyroid hormones that exerts an intense stimulus on the metabolism

Question 2

risk factors for a thyroid crisis/storm

Answer 2

-long standing untreated hypertyroidism (grave’s)
-acute event
-irregular use or discontinuation of antithyroid drugs

Question 3

thyroid storm manifestations

Answer 3

-fever
-tachycardia
-cardiac dysrhythmias (afib & aflutter) + if prolonged, heart failure
-N/v
-agitation
-tremor
-psychosis
-stupor/coma
-hypotension

Question 4

treatment for thyroid storm

Answer 4

-beta blockers
-thionamide (propylthiouracil/PTU) to block new hormone synthesis by suppressing conversion of T4 to T3
-iodine solution to block release of thyroid hormone
-glucocorticoids to reduce T4 -> T3, promote vasmotor stability and ~treat adrenal insuff
-bile acid sequestrants in severe cases to decrease enterohepatic circulation and recycling of thyroid hormones

Question 5

myxedema coma

Answer 5

severe hypothyroidism leading to decreased mental status, hypothermia, and slowing of functions of other organs
emergency w/ high mortality rate but uncommon

Question 6

myxedema coma risk factors

Answer 6

hypothyroidism
-long standing & severe
-acute event in poorly controlled pt
-administration of sedative drugs

Question 7

myxedema coma CM

Answer 7

-decreased mental status/coma
-hypothermia
-hypotension
-bradycardia
-hyponatremia (dilutional)
-hypoglycemia
-hypoventilation

Question 8

myxedema coma treatment

Answer 8

-thyroid hormone (levothyroxine & liothyronine), given IV w/ slow bolus -> daily dose
-glucocorticoids b/c pt will have adrenal insuff
-supportive measures: fluids, lytrs, glucose monitoring, treat infection if present, correct hypothermia