Thyroid Storm and Hyperthyroidism Flashcards
What are the most severe and life threatening consequences of hyperthyroidism?
Cardiovascular collapse and arrest
Coma and loss of airway from enlarged goiter
In what order should medications be given?
Beta blocker, thyroid function inhibitor, iodine, steroid
Meds and dosing for beta blockers?
Propranolol 0.5-1mg IV bolus q10 minutes titrate to HR <100 OR
Esmolol IV bolus 100-500 mcg/kg push followed by infusion start at 25-100 mcg/kg/min then titrate by 25 mcg/kg/min as needed
Difference between propranolol, esmolol, metoprolol, labetalol, carvedilol
Propranolol: non-selective beta 1 & 2
Metoprolol and Esmolol: selective beta 1 only
Labetalol and carvedilol: beta and alpha 1
What are the anti-thyroid medications and doses?
PTU: 500 mg PO load, 250 mg PO q4h OR
Methimazole: 40 mg PO load, 25 mg PO q6h
What are the iodide solutions and when can they be given?
Given at least 1 hour after anti-thyroid medications
Saturated solution of potassium iodide: 5 drops Q6hr
Lugol’s solution: 4-8 drops Q6-8hr
Why are steroids given and what options are there?
Prevent conversion of T4 to T3
Hydrocortisone 100mg Q8hr or
Dexamethasone2-4mg
Apart from tachycardia/blood pressure, what other vital sign needs to be treated?
Temperature
Use tylenol and cooling techniques
NSAID’s are contraindicated
Apart from treating hyperthyroidism directly, what else needs to be addressed?
The trigger, which could be infection, sepsis, metabolic abnormality, recent surgery, pregnancy, recently stopping medication
Many medications for hyperthyroidism are PO, what if the patient is unconscious?
NG tube or consider rectal
Sometimes Iodine cannot be given. What is the alternative and when is this needed?
Lithium is the alternative to Iodine.
Given when allergy to iodine or when Iodine or Amiodarone induced thyrotoxicosis is the precipitating cause.
What is the end-all treatment if all medications do not work?
Plasma Exchange
