Thyroid storm

Question 1

What is the pathophysiology of thyroid storm?

Answer 1

Excess thyroid hormone caused by
Primary overproduction
OR
Damage to gland causing hormone release
OR
excess iodine intake
OR
Excess intake of thyroid hormone

Question 2

What are the symptoms of a thyroid storm?

Answer 2

High RR
High HR & tachyarrhthmias ( esp AF)
High temp
Dehydration +/- rhabdo
electrolyte derangement - high sodium, low pot
Agitation and confusion

Question 3

What can cause a thyroid storm?

Answer 3

Graves dx
Goitre
thyroid malignancy
trauma

Question 4

What are common precipitants of a thyroid storm?

Answer 4

Infection - sepsis
Infarction - MI
Inflammation - surgery
Drugs - anticholinergics (atropine, glyco,ipratropium,) adrenergics, NSAIDS

Question 5

What are the differentials for a thyroid storm?

Answer 5

NMS
sepsis
MH
phaeochromacytoma

Question 6

What investigations would you do if you suspected a thyroid storm?

Answer 6

1)Bloods - FBC, CRP, cultures (look for infection), TFTs, U&ES (look for AKI & electrolytes), ABG (acidosis), glucose

2) Urine - MC&S, myoglobin, chatecholamines (to r/o phaeo)

3) ECG - arrhthmias
4)CXR - look for infection source
5)Echo - r/o MI

Question 7

How would you manage thryoid storm?

Answer 7

1) Supportive - oxygen/I&V (high metabolic rate), electrolyte replacement, arrhthmia mx - dig/amiodarone after treating endocrine abnormality, fluids, coolling

2) Treat precipitating factor

3) Treat endocrine abnormality - drugs

Question 8

What drugs might you use to treat thyroid storm?

Answer 8

Propanolol- decreases sympathetic activity and reduces conversion of T4 to T3

Propylthiouracil - reduces conversion of T4 to T3

Carbimazole - blocks thyroid hormone production

Steroids (dex or hydrocort) - correction of thyrotoxicosis may cause addisonian crisis