Thyroid Storm

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Thyroid Storm
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Thyroid Storm

• Thyroid storm (also know as thyrotoxic crisis) is
  an acute state of hyperthyroidism where all of
  the signs and symptoms are exaggerated.
• It can be life threatening but with quick
  response can be controlled and managed

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Triggers

• Trauma
• Infection
• Surgery

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Thyroid Storm

• Treatment is largely symptomatic and etiology
  dependent
• Look back at the treatments in your hyperthyroid
  module
• Think also about the bodys functioning and the
  exaggerated symptoms of hyperthyroidism that
  would be manifested during thyroid storm

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Storm Treatments

• Treatments directed at thyroid gland and hormones
• Inhibition of new hormone synthesis with
  Thioamide drugs such as PTU and methimazole
• Inhibition of hormone release with Iodine
  potassium iodide (Lugols solution) Lithium
  carbonate

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What the heck is Lugols solution?

• Also known as Lugols iodine, this oral solution
  is specifically indicated for patients with
  thyroid storm or preoperatively for a patient
  with hyperthyroidism
• It is a mix of iodine, potassium iodide and
  distilled water

• It is also used to enhance color and growth for
  coral in home aquariums!

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Storm Treatments

• Treatments directed at preventing hormones
  affects on the body
• Polythiouracil (PTU)
• Corticosteroids
• Beta blockers (most importantly Propanolol)
• Amiodarone
• Plasmapheresis

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Storm Treatments

• Treatments directed at maintaining homeostasis
• Hyperthermia acetaminophen, cooling blankets
• Fluid and electrolyte testing/replacement
• Glucose
• Vasopressors
• Digoxin diuretics if appropriate

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Treatment Summary

• Overall Goal Reduce circulation thyroid levels
  and control symptom
• Beta blockers decreases adrenergic hyperactivity
  (sympathetic outflow)
• PTU (large amounts) prevents synthesis of the
  hormone
• Glucocorticoids inhibit hormone production and
  decrease peripheral conversion from T4 to T3.
• Sodium iodide solution (Lugols solution) High
  levels of iodide will initially suppress release
  of thyroid hormone
• Treat cardiac symptoms, fever and hypertension

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Nursing Functions

• Initiate cardiac monitoring, have code supplies
  ready if cardiac symptoms worsen
• Monitor hemodynamic, respiratory thermic
  parameters to ensure that therapies are working
  (homeostasis)
• Keep patient safe and re-orient if acutely
  confused or highly anxious
• Identify trigger and treat/remove