Endo - Viva - Thyroid Flashcards
Define thyroid storm
Life threatening exacerbation fo hyperthyoid state with 1 or more organ dysfunction
Pathophys of thyroid storm
Primary: overproduction of thyroid hormone
Gland damage - release of hormone
Excess iodine - thyrotoxicosis
Causes of thyrotoxicosis
Grave's Disease Toixic goiter Thyroid adenoma Trauma Excess hormone
Precipitants of storm
Sepsis Truama Surgery MI Iodine contrast oad Poor DM Pregnancy Drugs - anticholinergics, NSAIDs
Presentation Thyroid storm
CVS - tachy, AF, flushed, sweatining, High output failure
Neuro - agitation, confusion, coma
Metabolic - fever, rhabdo, dehydration, high Na
GI - N/V/D
Thyroid disease - eye proptosis, hot skin, hair loss
Presentation of Thyroid Storm
CVS - tachy, AF, flushed, sweatining, High output failure
Neuro - agitation, confusion, coma
Metabolic - fever, rhabdo, dehydration, high Na
GI - N/V/D
Thyroid disease - eye proptosis, hot skin, hair loss
Ix in thyroid storm
Bloods - FBC, U&E, CRP, Culture, LFT, Clotting TFTs CK (rhabdo) Cortisol, ACTH Glucose (high) ABG
Urine - MC&S, myoglobin, cathetcholamines
CXR, ECG, Echo (MI is a cause)
Treatment Thyroid Storm
ABCDE…
Supportive, Cause, Endocine, Extra.
Support - O2, sedation/MV, fluid resus, arrhytmia management, CV support, electrolytes, cool the patient
Endocrine - Blockade, anti-thyroids, reduce conversion
Treatment Thyroid Storm
ABCDE…
Supportive, Cause, Endocine, Extra.
Support - O2, sedation/MV, fluid resus, arrhytmia management, CV support, electrolytes, cool the patient
Endocrine - Blockade, anti-thyroids, reduce conversion
Drugs to manage Thyroid Storm
Propanolol - Sympathetic control (also conversion)
PTU - blocks iodiniation ot tyrosine
Carbimazole - stops production
Steroids (usualy deficient)
Extra - dig, amio, Vit B, dantrolen, plex, lugol’s iodine
Myoxedemic coma
Rare fatal syndrome due to a deficiency of thyroid hormone
Cause of myxodemic coma
Undiagnosed/untreated hypothy
Hashimotos thyoid (autoimmune)
Previous iodine/thyroid surgery
Amiodarone
Pit/thyroid injury
Precipitants of myxodemic
Sepsis Trauma Surgery Sedatives Hypothermia Overtreating hyperthermia
Myoxodema - presentation
Resp - hypovent, hypoxia
CVS - brady, long QTc, T wave flat, effusion
CNS - seizures, stupour, coma
Met - hypothermia, low Na, high K, hypo glyc
Thy - coarse dry skin, periorbital oedema
Slow reflexes
Treat myxoedema
ABCDE.. Airway - low GCS C - fluid resus, saline (dilutional Na) Inotropes Treat cause Warm patient
Correct endocrine - Liothyonine (quick)
L-thyroixine
Steroids (BEFORE THYROXINE - Addisonian crisis)
