thyroid Flashcards
thyrotoxic crisis (thyroid storm)
overwhelming release of thyroid hormones that exert intense stimulus on met
rare and life threatening -> death w/n 48 hrs if not treated
commonly precipitated by sx, trauma, infection
rf
long standing hyperthy (graves)
acute stressor
irregular use or discontinuation of antithyroid drug
cm
fever >103, tachy >140, dysR (afib/flutter -> HF, pulm edema), n/v, agitation, tremor, psychosis, stupor/coma, hypoT (later, initially htn), diaphoretic (heat intol)
tm
BB
thionamide
iodine
glucocorticoids
bile acids sequestrants
tm: BB
control s/s of increased adrenergic tone
q6
tm: thionamide
propythiouracil/PTU
block new hormone synthesis (w/n 1-2 hrs after admin)
suppress T4 - T3 conversion
q4
tm: iodine
block thyroid hormone release
1hr after 1st dose of PTU
tm: glucocorticoids
decrease T4 - T3 conversion, promote vasomotor stability, possibly treat associated relative adrenal insuff
if clear evidence of thyroid storm
q8
tm: bile acid sequestrants
may also be of benefit in severe cases to decrease enterohepatic circulation and recycling of thyroid hormones
enterohepatic circ: liver metabolizes thyroid hormone, excrete in bile
q6
myxedema coma
severe hypothyroid: decreased mental status, hypotherm, slow function of organs
med emergency w/ high mortality rate
uncommon d/t earlier dx capability
myxedema: rf
hypothy
long standing, severe form
precipitating event in poorly controlled pt: infection, MI, cold exposure, sx
admin sedative drugs
myxedema: cm
decreased mental status (coma)
hypotherm (death), hypoT, brady, hypoNa (mental change, dilutional bc H2O not excreted), hypogly, hypovent (resp acidosis)
myxedema: tm
levothyroxine (T4) and liothyronine (T3)
glucocorticoids
supportive
myxedema: tm - levothyroxine and liothyronine
IV (until T4 orally)
slow bolus -> daily dose
myxedema: tm - glucocorticoids
until no more adrenal insuf
IV q8
