Thyroid Storm****

Question 1

What is another name for this?

Answer 1

Hyperthyroid crisis

Question 2

What triggers it?

Answer 2

Illness (e.g. infection)
Surgery
Trauma

Question 3

S+S:

Think about severe manifestations of hyperthyroidism

Answer 3

Fever

CV - tachycardia, AF, HF

D&V - acute abdomen

Confusion - coma

Question 4

Management:

(1) IV fluids:
- Why are fluids given?
- What can be done for vomiting? - not antiemetics

(2) What bloods should be taken?

(3) Propranolol is given if are no CI’s and the cardiac output is okay.
- Why should it not be given to those with asthma/poor cardiac output?
- What can be given instead?

Answer 4

To replace fluid loss due to D&V

NG tube

T3, T4 and TSH
—–
It has caused cardiac arrest in a thyroid storm

Short-acting beta-blockers - IV esmolol

Question 5

Management:

(4) What other cardiac drug may be used to control the HR quickly?

(5) Antithyroid drugs are used:
- Which drugs are used?
- Route?

(6) Steroids (Hydrocortisone/dexamethasone):
- Why are steroids prescribed?

Extras:

• Why may bile acid sequestrants (e.g. cholestyramine) given?
• What drug can be given to reduce a fever?

Answer 5

Digoxin - high dose

Propylthiouracil - 1st line
Carbimazole

NGT - not IV

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They prevent the peripheral conversion of T4 to T3 - remember T3 is stronger even though it is produced less by the gland but mainly by peripheral conversion
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Prevents T4 and T3 reabsorption in the gut

Paracetamol - tepid sponging can also be used