Thyroid storm ED treatment Flashcards
Treatment aims in Thyroid Storm (8)
- Supportive Care
- Inhibition of PERIPHERAL Adrenergic effects
- Inhibition of NEW hormone synthesis
- Inhibition of Thyroid hormone RELEASE
- Preventing PERIPHERAL CONVERSION of T4 to T3
- Preventing Free Thyroid Hormone REABSORPTION
- Treating Precipitant
- Definitive Care
Supportive Care
How do you manage fever
External cooling: ice packs or cooling blankets
Acetaminophen: 325-600mg PO or PR q4-6
Supporitve Care
Why is aspirin contraindicated
May increase free thyroid hormone
Supportive Care
Additional Nutrition to Give (4)
- Glucose
- Multivitamins
- Thiamine
- Folate
Medications for inhibition of peripheral adrenergic effects
- Propanolol
- Esmolol
- Reserpine
- Guanethidine
PERG
inhibition of peripheral adrenergic effects
Dose of Propanolol
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
Dose of Esmolol
250-500 micrograms/kg IV loading
then
50-100micrograms/kg/min titrated to effect
inhibition of peripheral adrenergic effects
Dose of Reserpine
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
Dose of Guanethidine
30-40mg PO q6
inhibition of peripheral adrenergic effects
consider using if B-blocker is contraindicated BUT avoid in congestive heart failure or hypotension
Drugs for inhibition of Thyroid Hormone Synthesis (2)
- Methimazole
- PTU
Dose of Methimazole
20mg q6 PO
Drugs for inhibition of Thyroid Hormone Synthesis
AVOID IN PREGNANCY; CAT D; TERATOGENIC IN 1st Trimester
Dose of PTU
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
Drugs of inhibition of Thyroid Hormone synthesis (5)
- Lugol solution
- Potassium iodide
- IV iopanoic acid
- Ipodate
- Lithium carbonate
When do you give drugs for inhibition of thyroid hormone release
at least 1hr after step 3
Dose of Lugol solution
8-10 drops PO q6-8
When do you give drugs for inhibition of thyroid hormone synthesis
Dose of SSKI
Potassium iodide
5 drops PO q6
0.25ml or 250mg
Drug for inhibition of thyroid hormone release that is pregnancy category C
Iopanoic acid
Espscially useful with thyroiditis or thyroid hormone overdose
Ipodate / Oragrafin
Drug for inhibition of thyroid hormone release that is contraindicated for pregnant
Litium carbonate
Drug and dose for preventing peripheral conversion of T4 to T3 (2)
- Hydrocortisone 300mg TIV initially then 100mg q8
- Dexamethasone 2mg TIV q6
Drug for prevention of free thyroid hormone reabsorption
Cholestyramine 4g q6
