Critical Hyperthyroidism: "Thyroid Storm"

Question 1

What is thyroid storm?

Answer 1

A severe, life-threatening exacerbation of thyrotoxicosis characterized by systemic decompensation.

Question 2

What are common triggers for thyroid storm?

Answer 2

Thyroid surgery, antithyroid drug withdrawal, radioiodine therapy, severe infection, or trauma.

Question 3

What are the major symptoms of thyroid storm?

Answer 3

High fever, significant mental status changes, multiorgan dysfunction, adrenergic crisis, and GI hypermotility (nausea, vomiting, diarrhea).

Question 4

What neurological symptoms may occur in thyroid storm?

Answer 4

CNS dysfunction ranging from agitation to coma.

Question 5

What are common cardiovascular manifestations of thyroid storm?

Answer 5

Tachycardia, hypertension, arrhythmias, and potential cardiac failure.

Question 6

What laboratory findings support a diagnosis of thyroid storm?

Answer 6

Elevated serum total and free T3/T4 levels with suppressed TSH, liver function derangements, leukocytosis or leukopenia.

Question 7

What tools can aid in recognizing thyroid storm?

Answer 7

Specific scoring systems based on clinical and laboratory parameters.

Question 8

Why is ICU admission critical for thyroid storm management?

Answer 8

For close monitoring and supportive care, given the life-threatening nature of the condition.

Question 9

How is hyperthermia managed in thyroid storm?

Answer 9

With cool IV fluids, antipyretics, or cooling blankets.

Question 10

What is the preferred antithyroid medication for thyroid storm?

Answer 10

Methimazole due to fewer side effects.

Question 11

What is the loading dose of Methimazole for thyroid storm?

Answer 11

60-100 mg loading dose, followed by 20-30 mg every 6-8 hours orally.

Question 12

Why is Propylthiouracil (PTU) less preferred in thyroid storm?

Answer 12

Due to more side effects, including hepatotoxicity.

Question 13

What is the role of iodine in thyroid storm treatment?

Answer 13

Blocks thyroid hormone release and peripheral conversion of T4 to T3.

Question 14

When should iodine be administered in thyroid storm treatment?

Answer 14

Two hours after thiourea drugs (e.g., Methimazole or PTU).

Question 15

What is the role of corticosteroids in thyroid storm management?

Answer 15

Hydrocortisone prevents peripheral conversion of T4 to T3 and supports adrenal function during the crisis.

Question 16

What is the recommended dose of hydrocortisone in thyroid storm?

Answer 16

50-100 mg IV every 6-8 hours.

Question 17

How are beta-blockers used in thyroid storm?

Answer 17

To control cardiovascular symptoms; esmolol is preferred in unstable patients due to its short half-life and easier titration.

Question 18

What extracorporeal treatments are considered in refractory thyroid storm cases?

Answer 18

Plasmapheresis or charcoal plasma perfusion to rapidly decrease circulating thyroid hormone levels.

Question 19

What should be monitored during thyroid storm treatment?

Answer 19

Vital signs, thyroid hormone levels, and response to treatment.

Question 20

How quickly should improvement be seen in thyroid storm?

Answer 20

Improvement is expected within 24 hours, but full recovery may take days to weeks.

Question 21

What are long-term management plans post-thyroid storm?

Answer 21

Continued medical therapy with plans for definitive treatment like radioactive iodine or thyroidectomy once stabilized.

Question 22

What are the risks of untreated thyroid storm?

Answer 22

Multiorgan failure and death due to severe systemic decompensation.

Question 23

What is the first step in managing a suspected thyroid storm?

Answer 23

Admission to the ICU for monitoring and initiation of supportive care and specific therapies.

Question 24

Why is interdisciplinary care important in thyroid storm management?

Answer 24

Collaboration with endocrinologists, cardiologists, and intensivists ensures comprehensive care for systemic complications.

Question 25

What is the role of sedation in thyroid storm management?

Answer 25

Sedatives like Phenobarbital are used to calm agitation and enhance thyroid hormone clearance.