Thyroid storm
because i like these weird icu things
| life-threatening exacerbation of hyperthyroid state with >1 organ dysfunction | |
|---|---|
| Etiology | systemic disease: sepsis, surgery, trauma, burns, seizure... thyroid-specific causes: radioactive iodine therapy, cessation of antithyroid drugs |
| Epidemiology | |
| Clinical presentation | A - goitre could cause airway compromise B - ↑ MV due to ↑ metabolism C - tachycardia, arrhythmias, heart failure; hypotension is a late sign D - altered mental state E - ↑ cortisol, ↓ K/Mg F - "thyrotoxic myopathy": ↑ CK, Rhabdomyolysis |
| Pathogenesis | |
| Diagnostic investigations | |
| Management | Resuscitation: cooling, paracetamol (avoiding NSAIDs as antipyretic) Specific: - block peripheral T4 activity: propranolol/esmolol - hydrocortisone, THEN inorganic iodine therapy - prevent synthesis of T3, T4: propylthiouracil loading + maintenance - blockade of enterohepatic recirculation of thyroid hormone: cholestyramine - PLEX can clear thyroid hormone! |