Thyroid Storm/Myxedema Flashcards
thyrotoxic crisis (storm)
overwhelming release of thyroid hormones that exerts an intense stimulus on the metabolism
what brings about a thyrotoxic crisis?
surgery, trauma, or infection
risk factors for thyrotoxic crisis (storm)
–long-standing untreated hyperthyroidism (Graves’ disease)
–acute event
–irregular use or discontinuation of antithyroid drugs
thyroid storm manifestations
–fever
–tachy > 140
–cardiac dysrhythmias
–N/V
–agitation
–tremor
–psychosis
–stupor/coma
–hypotension
meds to help with thyroid storms
–beta blocker
–thionamide (propylthiouracil)
–iodine solution
–glucocorticoids
–bile acid sequestrants
purpose of beta blocker in treatment of storm
controls symptoms and signs induced by increased adrenergic tone (q 6 hours)
purpose of thionamide in treatment of storm
–block new hormone synthesis
–suppresses conversion of T4 to T3
–q 4 hours
purpose of iodine solution in treatment of storm
blocks release of thyroid hormone
purpose of glucocorticoids in treatment of storm
–reduce T3-to-T4 conversion
–promotes vasomotor stability
–possibly treat an associated relative adrenal insufficiency
–q 8 hours
purpose of bile acid sequestrants in treatment of storm
may benefit in severe cases to decrease enterohepatic circulation and recycling of thyroid hormones (q 6 hours)
what is a myxedema coma?
severe hypothyroidism leading to decreased mental status, hypothermia, and slowing of functions of other organs
specifics of myxedema coma
–medical emergency with high mortality rate
–uncommon due to earlier diagnosis capability
risk factors for myxedema coma
–hypothyroidism (long standing and severe)
–precipitating acute event in poorly controlled in patient with hypothyroidism (infection, MI, cold exposure, surgery)
–admin of sedative drugs
clinical manifestations of myxedema coma
–decreased mental status (coma)
–hypothermia
–hypotension
–bradycardia
–hyponatremia
–hypoglycemia
–hypoventilation
treatment for myxedema coma
–thyroid hormone (levothyroxine and liothyronine)
–glucocorticoids
–supportive measures (IVF, electrolytes, mech. ventilation, glucose monitoring and replacement, correction of hypothermia, treat underlying infection)
