Viva - Thyroid Flashcards

1
Q

Define thyroid storm

A

Life threatening exacerbation fo hyperthyoid state with 1 or more organ dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pathophys of thyroid storm

A

Primary: overproduction of thyroid hormone

Gland damage - release of hormone

Excess iodine - thyrotoxicosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes of thyroid storm

A
Grave's Disease
Toixic goiter
Thyroid adenoma
Trauma
Excess hormone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Precipitants of storm

A
Sepsis
Truama
Surgery
MI
Iodine contrast oad
Poor DM
Pregnancy
Drugs - anticholinergics, NSAIDs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Presentation

A

CVS - tachy, AF, flushed, sweatining, High output failure

Neuro - agitation, confusion, coma

Metabolic - fever, rhabdo, dehydration, high Na

GI - N/V/D

Thyroid disease - eye proptosis, hot skin, hair loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Presentation

A

CVS - tachy, AF, flushed, sweatining, High output failure

Neuro - agitation, confusion, coma

Metabolic - fever, rhabdo, dehydration, high Na

GI - N/V/D

Thyroid disease - eye proptosis, hot skin, hair loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Ix in thyroid storm

A
Bloods - FBC, U&E, CRP, Culture, LFT, Clotting
TFTs
CK (rhabdo)
Cortisol, ACTH
Glucose (high)
ABG

Urine - MC&S, myoglobin, cathetcholamines
CXR, ECG, Echo (MI is a cause)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Treatment

A

ABCDE…
Supportive, Cause, Endocine, Extra.

Support - O2, sedation/MV, fluid resus, arrhytmia management, CV support, electrolytes, cool the patient

Endocrine - Blockade, anti-thyroids, reduce conversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment

A

ABCDE…
Supportive, Cause, Endocine, Extra.

Support - O2, sedation/MV, fluid resus, arrhytmia management, CV support, electrolytes, cool the patient

Endocrine - Blockade, anti-thyroids, reduce conversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Drugs

A

Propanolol - Sympathetic control (also conversion)

PTU - blocks iodiniation ot tyrosine

Carbimazole - stops production

Steroids (usualy deficient)

Extra - dig, amio, Vit B, dantrolen, plex, lugol’s iodine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Myoxedemic coma

A

Rare fatal syndrome due to a deficiency of thyroid hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cause of myxodemic coma

A

Undiagnosed/untreated hypothy

Hashimotos thyoid (autoimmune)

Previous iodine/thyroid surgery

Amiodarone

Pit/thyroid injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Precipitants of myxodemic

A
Sepsis
Trauma
Surgery
Sedatives
Hypothermia
Overtreating hyperthermia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Myoxodema - presentation

A

Resp - hypovent, hypoxia
CVS - brady, long QTc, T wave flat, effusion

CNS - seizures, stupour, coma

Met - hypothermia, low Na, high K, hypo glyc

Thy - coarse dry skin, periorbital oedema
Slow reflexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Treat myxoedema

A
ABCDE..
Airway - low GCS
C - fluid resus, saline (dilutional Na)
Inotropes
Treat cause
Warm patient

Correct endocrine - Liothyonine (quick)
L-thyroixine
Steroids (BEFORE THYROXINE - Addisonian crisis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly