Thanks to Dr. Kopping for today’s Morning Report!
THYROID STORM
Thyrotoxicosis represents anywhere from 0.05% to 1.3%
- Storm represents <10% of hospitalized
- However untreated 80 to 100% mortality
- Drops to 20 to 30% with treatment
What makes the difference from thyrotoxicosis to thyroid storm?
- Comparable levels
- Precipitating factors- some sort of physiologic stressor
- Infection(most common)
- Trauma, MI, CVA, PE, DKA, surgery (particularly thyroid), Iodine administration(dye, amiodoarone), abruptly stopping antithyroid meds
- Adrenergic hyperactivity- release from binding sites or increase binding site sensitivity
- Cause a lot of biochemical changes downstream that is beyond my capacity
When is it thyroid storm?
- Burch & Wartofsky Diagnostic Criteria (http://wikem.org/wiki/Thyroid_Storm)
5 Step Treatment Approach
- Supportive care- IV, fever control, nutrition (dextrose, multivitamin, thiamine, folate), O2 as needed, cardiac monitoring
- Inhibition of thyroid release- PTU (preferred) or methimazole
- Inhibition of NEW thyroid release MUST be done AT LEAST 1 hour after (ie Lugol solution, potassium iodide, IV iopanoic acid, Iopdate, Lithium carbonate
- B adrenergic receptor blockade (propranolol, esmolol, rerpine/guanethidine if BB contraindicated)
- Prevent peripheral conversion (Hydrocortisone or dexamethasone)
Above all else…
FIND AND TREAT THE PRECIPITATING EVENT!!
References:
http://accessmedicine.mhmedical.com.newproxy.downstate.edu/ViewLarge.aspx?figid=40403707
Nayak, B; Burman, K “Thyrotoxicosis and Thyroid Storm”
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD
Editor in Chief of "The Original Kings of County"
Assistant Professor of Emergency Medicine
Assistant Residency Director
SUNY Downstate / Kings County Hospital
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