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ALL / Endocrinology
Thyroid storm
Thyroid storm
Thyroid storm is a rare but life-threatening complication of thyrotoxicosis. It is typically seen in patients with established thyrotoxicosis and is rarely seen as the presenting feature. Iatrogenic thyroxine excess does not usually result in thyroid storm.Precipitating events:
- thyroid or non-thyroidal surgery
- trauma
- infection
- acute iodine load e.g. CT contrast media
Clinical features include:
- fever > 38.5ºC
- tachycardia
- confusion and agitation
- nausea and vomiting
- hypertension
- heart failure
- abnormal liver function test - jaundice may be seen clinically
Management:
- symptomatic treatment e.g. paracetamol
- treatment of underlying precipitating event
- beta-blockers: typically IV propranolol
- blocks peripheral effects of thyroid hormone
- anti-thyroid drugs: e.g. methimazole or propylthiouracil
- blocks new hormone synthesis
- Lugol's iodine (iodine solution)
- prevents further thyroid hormone release.
- glucocorticoids
- reduce peripheral conversion of T4 → T3
- IV hydrocortisone or dexamethasone
+PassMedicine Notes
Thyroid storm is a rare but life-threatening complication of thyrotoxicosis. It is typically seen in patients with established thyrotoxicosis and is rarely seen as the presenting feature. Iatrogenic thyroxine excess does not usually result in thyroid storm.
Precipitating events:- thyroid or non-thyroidal surgery
- trauma
- infection
- acute iodine load e.g. CT contrast media
- fever > 38.5ºC
- tachycardia
- confusion and agitation
- nausea and vomiting
- hypertension
- heart failure
- abnormal liver function test - jaundice may be seen clinically
- symptomatic treatment e.g. paracetamol
- treatment of underlying precipitating event
- beta-blockers: typically IV propranolol
- blocks peripheral effects of thyroid hormone
- anti-thyroid drugs: e.g. methimazole or propylthiouracil
- blocks new hormone synthesis
- Lugol's iodine (iodine solution)
- prevents further thyroid hormone release.
- glucocorticoids
- reduce peripheral conversion of T4 → T3
- IV hydrocortisone or dexamethasone
