Thyroid Emergencies Flashcards
1
Q
What is myxoedema coma?
A
- The ultimate thyroid state before death
2
Q
What are signs and symptoms of myxoedema coma?
A
- Looks hypothyroid
- Often over 65
- Hypothermia, hyporeflexia, low glucose, bradycardia, coma, seizures, psychosis
3
Q
What are precipitants of myxoedema coma?
A
- Infection
- MI
- Stroke
- Trauma
- Patients may have had radioiodine, thyroidectomy, pituitary surgery
4
Q
What would you find on examination for myxoedema coma?
A
- Goitre
- Cyanosis
- Low BP (cardiogenic shock)
- Heart failure
- Signs of precipitants
5
Q
What bloods would you take when suspecting myxoedema coma?
A
- T3, T4, TSH
- FBC, U+E (low Na)
- Cultures
- Cortisol
- Glucose
- ABG for pO2
6
Q
What is the treatment for myxoedema coma?
A
- Correct hypoglycaemia
- Give T3 IV slowly (may cause IHD be careful)
- Give hydrocortisone IV
- Give antibiotic if infection suspected
- Warm patient if they have hypothermia
7
Q
What is a thyrotoxic storm?
A
- A hyperthyroid crisis
8
Q
What are the symptoms of a thyrotoxic storm?
A
- Severe hyperthyroidism
- Increased temperature
- Agitation, confusion, coma, tachycardia, AF, D+V, goitre, thyroid bruit, acute abdomen, heart failure
9
Q
What are precipitants to a thyrotoxic storm?
A
- Recent thyroid surgery or radioiodine
- MI
- Trauma
10
Q
What investigations would you undertake for thyrotoxic storm?
A
- TSH, free T3, free T4
- Confirm which technetium uptake if possible
- Cultures if suspected infection
- Urgent treatment required so do not wait for results
11
Q
What is the management for thyrotoxic storm?
A
- A-E
- Sedate if necessary, monitor BP
- Propranolol to slow heart if not CI
- High dose digoxin to slow heart
- Carbimazole to block thyroid and Lugol’s solution
- Hydrocortisone prevents conversion of T4 to T3
- Treat infection if required and lower fever with paracetamol
