Critical Hyperthyroidism: "Thyroid Storm" Flashcards
What is thyroid storm?
A severe, life-threatening exacerbation of thyrotoxicosis characterized by systemic decompensation.
What are common triggers for thyroid storm?
Thyroid surgery, antithyroid drug withdrawal, radioiodine therapy, severe infection, or trauma.
What are the major symptoms of thyroid storm?
High fever, significant mental status changes, multiorgan dysfunction, adrenergic crisis, and GI hypermotility (nausea, vomiting, diarrhea).
What neurological symptoms may occur in thyroid storm?
CNS dysfunction ranging from agitation to coma.
What are common cardiovascular manifestations of thyroid storm?
Tachycardia, hypertension, arrhythmias, and potential cardiac failure.
What laboratory findings support a diagnosis of thyroid storm?
Elevated serum total and free T3/T4 levels with suppressed TSH, liver function derangements, leukocytosis or leukopenia.
What tools can aid in recognizing thyroid storm?
Specific scoring systems based on clinical and laboratory parameters.
Why is ICU admission critical for thyroid storm management?
For close monitoring and supportive care, given the life-threatening nature of the condition.
How is hyperthermia managed in thyroid storm?
With cool IV fluids, antipyretics, or cooling blankets.
What is the preferred antithyroid medication for thyroid storm?
Methimazole due to fewer side effects.
What is the loading dose of Methimazole for thyroid storm?
60-100 mg loading dose, followed by 20-30 mg every 6-8 hours orally.
Why is Propylthiouracil (PTU) less preferred in thyroid storm?
Due to more side effects, including hepatotoxicity.
What is the role of iodine in thyroid storm treatment?
Blocks thyroid hormone release and peripheral conversion of T4 to T3.
When should iodine be administered in thyroid storm treatment?
Two hours after thiourea drugs (e.g., Methimazole or PTU).
What is the role of corticosteroids in thyroid storm management?
Hydrocortisone prevents peripheral conversion of T4 to T3 and supports adrenal function during the crisis.
What is the recommended dose of hydrocortisone in thyroid storm?
50-100 mg IV every 6-8 hours.
How are beta-blockers used in thyroid storm?
To control cardiovascular symptoms; esmolol is preferred in unstable patients due to its short half-life and easier titration.
What extracorporeal treatments are considered in refractory thyroid storm cases?
Plasmapheresis or charcoal plasma perfusion to rapidly decrease circulating thyroid hormone levels.
What should be monitored during thyroid storm treatment?
Vital signs, thyroid hormone levels, and response to treatment.
How quickly should improvement be seen in thyroid storm?
Improvement is expected within 24 hours, but full recovery may take days to weeks.
What are long-term management plans post-thyroid storm?
Continued medical therapy with plans for definitive treatment like radioactive iodine or thyroidectomy once stabilized.
What are the risks of untreated thyroid storm?
Multiorgan failure and death due to severe systemic decompensation.
What is the first step in managing a suspected thyroid storm?
Admission to the ICU for monitoring and initiation of supportive care and specific therapies.
Why is interdisciplinary care important in thyroid storm management?
Collaboration with endocrinologists, cardiologists, and intensivists ensures comprehensive care for systemic complications.
What is the role of sedation in thyroid storm management?
Sedatives like Phenobarbital are used to calm agitation and enhance thyroid hormone clearance.
