Thyroid storm ED treatment Flashcards

1
Q

Treatment aims in Thyroid Storm (8)

A
  1. Supportive Care
  2. Inhibition of PERIPHERAL Adrenergic effects
  3. Inhibition of NEW hormone synthesis
  4. Inhibition of Thyroid hormone RELEASE
  5. Preventing PERIPHERAL CONVERSION of T4 to T3
  6. Preventing Free Thyroid Hormone REABSORPTION
  7. Treating Precipitant
  8. Definitive Care
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2
Q

Supportive Care

How do you manage fever

A

External cooling: ice packs or cooling blankets
Acetaminophen: 325-600mg PO or PR q4-6

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3
Q

Supporitve Care

Why is aspirin contraindicated

A

May increase free thyroid hormone

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4
Q

Supportive Care

Additional Nutrition to Give (4)

A
  1. Glucose
  2. Multivitamins
  3. Thiamine
  4. Folate
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5
Q

Medications for inhibition of peripheral adrenergic effects

A
  1. Propanolol
  2. Esmolol
  3. Reserpine
  4. Guanethidine

PERG

inhibition of peripheral adrenergic effects

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6
Q

Dose of Propanolol

A

0.5-1mg TIV over 10 mins
then
1-2mg every few hrs to effect

OR

60-80mg PO q4

inhibition of peripheral adrenergic effects

For reactive airway diseases: Atenolol, Metoprolol, CCB

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7
Q

Dose of Esmolol

A

250-500 micrograms/kg IV loading
then
50-100micrograms/kg/min titrated to effect

inhibition of peripheral adrenergic effects

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8
Q

Dose of Reserpine

A

1mg test dose
then
2.5 to 5.0 mg IM q4-6

inhibition of peripheral adrenergic effects

consider using if B-blocker is contraindicated BUT avoid in congestive heart failure or hypotension

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9
Q

Dose of Guanethidine

A

30-40mg PO q6

inhibition of peripheral adrenergic effects

consider using if B-blocker is contraindicated BUT avoid in congestive heart failure or hypotension

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10
Q

Drugs for inhibition of Thyroid Hormone Synthesis (2)

A
  1. Methimazole
  2. PTU
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11
Q

Dose of Methimazole

A

20mg q6 PO

Drugs for inhibition of Thyroid Hormone Synthesis

AVOID IN PREGNANCY; CAT D; TERATOGENIC IN 1st Trimester

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12
Q

Dose of PTU

A

LD: 500 to 1000mg PO
then
250mg q4

Drugs for inhibition of Thyroid Hormone Synthesis

Given in the 1st trimester
Rare SE: Severe hepatic dysfunction, hepatic failure in mother and fetus

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13
Q

Drugs of inhibition of Thyroid Hormone synthesis (5)

A
  1. Lugol solution
  2. Potassium iodide
  3. IV iopanoic acid
  4. Ipodate
  5. Lithium carbonate
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14
Q

When do you give drugs for inhibition of thyroid hormone release

A

at least 1hr after step 3

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15
Q

Dose of Lugol solution

A

8-10 drops PO q6-8

When do you give drugs for inhibition of thyroid hormone synthesis

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16
Q

Dose of SSKI

Potassium iodide

A

5 drops PO q6

0.25ml or 250mg

17
Q

Drug for inhibition of thyroid hormone release that is pregnancy category C

A

Iopanoic acid

18
Q

Espscially useful with thyroiditis or thyroid hormone overdose

A

Ipodate / Oragrafin

19
Q

Drug for inhibition of thyroid hormone release that is contraindicated for pregnant

A

Litium carbonate

20
Q

Drug and dose for preventing peripheral conversion of T4 to T3 (2)

A
  1. Hydrocortisone 300mg TIV initially then 100mg q8
  2. Dexamethasone 2mg TIV q6
21
Q

Drug for prevention of free thyroid hormone reabsorption

A

Cholestyramine 4g q6