Endocrinology

Question 1

What may lead to a thyroid storm?

Answer 1

1. Rare, life threatening complication of thyrotoxicosis

Precipitating events
- thyroid or non thyroidal surgery
- trauma
- infection
- acute iodine load

Question 2

Clinical features of thyroid storm?

Answer 2

Clinical features include:
- fever > 38.5ºC
- tachycardia
- confusion and agitation
- nausea and vomiting
- hypertension
- heart failure
- abnormal liver function test
- jaundice may be seen clinically

Question 3

Management of thyroid storm?

Answer 3

Management:
1. symptomatic treatment e.g. paracetamol
2. treatment of underlying precipitating event
3. beta-blockers: typically IV propranolol
4. anti-thyroid drugs: e.g. methimazole or propylthiouracil
5. Lugol’s iodine
6. dexamethasone - e.g. 4mg IV qds - blocks the conversion of
T4 to T3

Question 4

Diabetes mellitus: sick day rules

Answer 4

If patient unwell –> DO NOT STOP INSULIN
–> risk of DKA
–> concurrent illness can raise blood sugars

TYPE 1 DIABETES
1. If on INSULIN DO NOT STOP.
2. Check BG frequently 1-2hrs
3. consider checking blood or urinary ketone levels
4. maintain normal meal pattern if possible
5. 3L fluid (prevent dehydration)

TYPE 2 DIABETES
1. temporarily stop some oral hypoglycaemics during acute illness
2. restart meds once pt feeling better, eating + drinking for 24-48hrs
—–> Metformin –> stop tx if risk of dehydration, reduce risk of lactic acidosis
—–> SGLT-2i –> risk of euglycaemic DKA (check ketones, STOP if acutely unwell)
—–> Sulfonylurea –> may increase risk of hypoglycaemia
—–> GLP-1 receptor agonists –> stop if risk of dehydration
3. If on INSULIN DO NOT STOP
4. check BG more frequently