Thyroid Storm

Question 1

Risk Factors

Answer 1

Stress
Infection
Surgery
Radioactive Iodine therapy

Question 2

Pathophysiology

Answer 2

Rapid deterioration of thyrotoxicosis
- Rapid T4 increase

Question 3

Aetiology

Answer 3

Secondary to a precipitating factor such as infection or trauma in patients with known hyperthyroidism
May also be the first manifestation of undiagnosed hypothyroidism.

Question 4

Signs

Answer 4

Hyperpyrexia >40 degrees Celsius
Tachycardia > 140 BPM with or without A. fib
Extreme restlessness
Delirium
Reduced GCS
Coma
Death

Question 5

Symptoms

Answer 5

Nausea and vomiting
Diarrhoea,
Abdo pain
Jaundice
Confusion, delirium or coma

Question 6

Diagnosis

Answer 6

TFT’s: High T3/T4, Low TSH
ECG: Tachycardia + maybe A.fib
Blood glucose: perform in all patients with reduced GCS

Question 7

Treatment

Answer 7

IV fluids + NG tube (if vomiting) + tepid sponging
Fl: PROPOTHIOURACIL
SL: CARBIMAZOLE
IV HYDROCORTISONE - inhibits peripheral conversion of T4 -> T3
or METHYL PREDNISOLONE