0%
Topic
Review Topic
0
0
N/A
N/A
Questions
2
0
0
100%
0%
Evidence
1
0
0
Topic
Snapshot
  • A 34-year-old female with a past medical history of well-controlled Graves disease is brought to the emergency room for altered mental status. She is post-operative day 4 from an laparoscopic appendectomy for acute appendicitis. Her temperature is 104.2°F (40.1°C), blood pressure is 160/110 mmHg, pulse is 145/min, respirations are 21/min, and oxygen saturation is 95% on room air.
Introduction
  • Clinical definition
    • life threatening condition characterized by symptoms of severe thyrotoxicosis (excessive thyroid hormone in the body)
    • often precipitated by an acute event/trigger
  • Epidemiology
    • risk factors
      • longstanding, untreated hyperthyroidism
      • surgery
      • trauma
      • infection
      • parturition
      • irregular use or discontinuation of antithyroid drugs
  • Associated conditions
    • hyperthyroidism
Presentation
  • Symptoms
    • agitation
    • anxiety
    • delirium
    • coma
    • nausea/vomiting
    • diarrhea
    • abdominal pain
  • Physical exam
    • tachyarrythmia (can exceed 140 bpm)
    • hypotension/hypertension
    • hyperpyrexia
    • jaundice
Studies 
  • Diagnostic testing
    • diagnostic approach
      • diagnosis is clinical and based the on presence of severe and life-threatening symptoms (e.g., hyperpyrexia, cardiovascular dysfunction, and altered mentation) in a patient with biochemical evidence of hyperthyroidism (e.g., elevated free T4/T3 and low TSH)
    • studies
      • thyroid function tests
        • usually not more profound than that seen in patients with uncomplicated thyrotoxicosis
        • low TSH
        • high free T4 and/or T3
      • liver function test
        • may see abnormal liver function tests
Differential 
  • Sepsis 
    • distinguishing factors
      • rarely the extreme tachycardia seen in thyroid storm
      • thyroid functioning tests will likely be normal in sepsis
Treatment 
  • Management approach
    • management should be immediate following clinical diagnosis and patients should be managed at the intensive care unit (ICU) due to high mortality
  • First-line
    • β-blocker 
      • control the symptoms and signs (e.g., tachycardia) induced by increased adrenergic tone  
      • example
        • propranolol 
    • thionamide
      • blocks new hormone synthesis
      • effective within 1-2 hours post administration
      • example
        • propylthiouracil (PTU) or methimazole
    • iodine solution
      • blocks release of thyroid hormone
        • known as the Wolff-Chaikoff effect
        • effective within 1-2 hours post administration
    • glucocorticoid
      • reduces T4 to T3 conversion
      • promotes vasomotor stability
      • reduce autoimmune process in Graves disease
      • treat associated relative adrenal insufficiency
  • Long-term management
    • in patients with Graves disease, definitive therapy with radioactive iodine or thyroidectomy may be indicated 
Complications
  • Arrhythmias
  • Decompensated heart failure
  • Death

Please rate topic.

Average 4.7 of 7 Ratings

Questions (2)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Evidence (1)
EXPERT COMMENTS (6)
Private Note