Thyroid Storm / Adisonian Crisis Management Flashcards
What are the symptoms of Thyroid Storm?
List symptoms of long-standing hyperthyroidism.
- Weight loss
- Insomnia
- Anxiety
- Oligo- or amenorrhoea
What are potential causes of hyperthyroidism?
- Autoimmune condition (Graves’)
- Recent viral infection (De Quervain’s)
- Family history of Graves’
- Drugs (amiodarone, levothyroxine)
- Recent pregnancy or miscarriage
What are some differential diagnoses for hyperthyroidism?
- Graves’s disease
- Plummer disease (toxic multinodular goitre)
- Solitary toxic nodule (thyroid adenoma)
- Postpartum thyroiditis
- Amiodarone-induced hyperthyroidism
What are the findings of hyperthyroidism during a thyroid exam?
- Fine tremor
- Brisk reflexes
- Goitre (nodular or smooth)
- Thyroid eye disease
- Pretibial myxedema
- Thyroid acropachy
What investigations are used for Thyroid Storm?
- ECG
- FBC
- U&E
- CRP
- TFTs
What additional blood tests may be considered based on clinical judgment?
- Blood cultures
- Troponin
- Antibodies (TSH receptor antibodies, Anti-TPO, Anti-thyroglobulin)
What imaging is used for Thyroid Storm?
- Radioiodine uptake (RAIU)
- Doppler US of thyroid
What are the immediate treatments for hyperthyroidism?
- Antithyroid drug (e.g PTU or high dose carbimazole)
- Lugol’s iodine
- Steroids (e.g. Dexamethasone)
- Anxiolytic (e.g. chlorpromazine)
What are the symptoms of Addisonian Crisis?
- Fatigue
- Abdominal pain
- Diarrhea and vomiting
- Collapse
What is a significant history factor for Addisonian Crisis?
Sudden cessation of long-term or high-dose steroid treatment
List risk factors for Addisonian Crisis.
- Immune checkpoint inhibitors (e.g. ipilimumab)
- Addison’s disease
- Pituitary disease
- Infection (Waterhouse-Friderichsen syndrome)
What are the focused exam findings for Addisonian Crisis?
- Increased pigmentation
- Cushingoid features
What are the blood tests for Addisonian Crisis?
- FBC
- U&E
- Glucose
- Ca2+
What is the initial treatment for Addisonian Crisis?
IV hydrocortisone 100 mg STAT, followed by 50 mg IV TDS
What tests confirm or differentiate adrenal insufficiency when stable?
- Early morning cortisol
- Short synacthen test
What is the standard replacement treatment for primary adrenal insufficiency?
- 10 mg hydrocortisone morn + 5 mg lunch
- Fludrocortisone (once hydrocortisone <50 mg/day)
What does sik day tules apply to?
Drugs Held?
Double glucocorticoid dose
sulfonylurea, ACEi, diuretics, metformin, ARBs, NSAIDs, SGLT2 inhibitors
