Endocrine Emergencies of the Thyroid

Question 1

what is a thyrotoxic crisis (thyroid storm)

Answer 1

overwhelming release of thyroid that exerts intense stimulus of metabolism

Question 2

is a thyroid storm deadly?

Answer 2

yes, it is rare, precipitated by surgery, trauma, or infection

Question 3

risk factors for a thyroid storm

Answer 3

long standing untreated hyperthyroidism (graves)
acute events
irregular use or discontinuation of anti-thyroid drugs

Question 4

manifestations for a thyroid storm

Answer 4

fever
tachy >140
cardiac dysrhythmias (a-fib/flutter)
n/v
agitation
tremor
psychosis
stupor/coma
hypotension

Question 5

treatment of thyroid storm

Answer 5

beta blocker
thionamide (PTU)
iodine solution
glucocorticods
bile acid sequestrants

Question 6

what do beta blockers do during thyroid storm

Answer 6

to control symptoms and signs induced by increased adrenergic tone
given Q6

Question 7

what is thionamde (PTU) used for during thyroid storm

Answer 7

to block new hormone synthesis, suppresses conversion of T4 to T3
given q4

Question 8

what is iodine solution used for during thyroid storm

Answer 8

to block release of thyroid hormone

Question 9

what are glucocorticoids used for during thyroid storm

Answer 9

to reduce T4 to T3 conversion, promote vasomotor stability, and possibly treat an associated relative adrenal insufficiency
given q8

Question 10

What are bile acid sequestrants used for during thyroid storm

Answer 10

may be of benefit in severe cases to decrease enterohepatic circulation and recycling of thyroid hormones.
Given q6

Question 11

what causes myxedema coma

Answer 11

severe hypothyroidism leading to decreased LOC, hypothermia, and slows functions of organs

Question 12

is myxedema coma fatal?

Answer 12

yes and a medical emergency

Question 13

risk factors for myxedema coma

Answer 13

hypothyroidism- long standing and severe

Question 14

what are precipitating events of myxedema coma?

Answer 14

poorly controlled hypothyroidism
infection, MI, cold exposure, surgery
administration of sedative drugs

Question 15

clinical manifestations of myxedema coma

Answer 15

decreased LOC
coma
EVERYTHING IS LOW
hypothermia, hypotension, bradycardia, hyponatremia, hypoglycemia, hypoventilation

Question 16

Treatment of myxedema coma

Answer 16

thyroid hormone (levothyroxine and liothyronine) IV, slow bolus then daily doses
Glucocorticoids- IV dose q8 hours
ICU, IV fluids, electrolyte replacement, mechanical ventilation, glucose monitoring and replacement, correction of hypothermia, treat underlying infection.