11- THYROID STORM

• Medical emergency


  Can rapidly progress to circulatory failure
• Thyrotoxicosis with end-organ damage

  • Fever
  • Neuropsychiatric features
• Aggressive supportive treatment

  1. ICU admission

  2. NS/dextrose

  3. Antipyretics: acetaminophen (not aspirin/NSAIDs à will make it worse)

  4. Cooling and oxygen if needed

  5. Treat heart failure if present
• Address thyroid hormone excess

  1. Prevent peripheral conversion of T4 to active T3: Beta blockers ex: propranolol (+ symptomatic relief)

  2. Block new hormone synthesis: PTU or methimazole and carbimazole (PTU also blocks conversion of T4 to T3)

  3. Block release of preformed hormone= inorganic iodine [SSKI, Lugol's]. Must block synthesis (PTU) before giving iodine (wait for 1 hr then give)

  4. Glucocorticoids

  5. Decrease enterohepatic recycling: cholestyramine
• Look for precipitating illness and treat it