Thyroid Storm/ Myxedmea

Question 1

What is a thyroid storm

Answer 1

Overwhelming release of thyroid hormones that exerts an intense stimulus on the metabolism. It is rare, life-threatening, and most commonly due to surgery, trauma or infection

Question 2

Risk factors for a thyroid storm

Answer 2

Long-standing untreated hyperthyroidism, an acute event, irregular use or discontinuation of anti-thyroid drug

Question 3

Thyroid storm manifestations

Answer 3

Fever, tachycardia often over 140, cardiac dysrhythmias such as a fib or flutter, nausea, vomiting, agitation, trimmer, psychosis, stupor, comatose, hypotension

Question 4

Treatment of thyroid storm

Answer 4

Beta blocker (control s/Sx q6hr)
Thionamide (to block new hormone synthesis q4hr)
Iodine solution (blocks release of thyroid hormone)
Glucocorticoids (reduce T3-T4 conversion, vasomotor stability, and Tx associated adrenal insufficiency, q8hr)
Bile acid seqestrants (decreases enterohepatic circulation, q6hr)

Question 5

What is myxedema coma

Answer 5

Severe hypothyroidism leading to decrease mental status, hypothermia, and slowing of functions of other organs. Medical emergency, high mortality rate. Uncommon due to early diagnosis capability

Question 6

Risk factors for myxedema

Answer 6

Long-standing and severe hypothyroidism, precipitating acute event and poorly controlled hypothyroidism, administration of sedative drugs such as opioids

Question 7

Clinical manifestations of myxedema

Answer 7

Decreased mental status initially that can lead To comatose state, hypothermia, hypotension, bradycardia, hyponatremia, hypoglycemia, hypoventilation

Question 8

Treatment of myxedema

Answer 8

Thyroid hormone (leothyroxine and liothyronine. IV w/ slow bolus then daily dose)
Glucocorticoids (IV Q8hr)
Supportive measures (ICU, IV fluids, electrolyte replacement, mechanical ventilation, glucose monitoring and replacement, correction of hypo thermia, treatment underlying infection if that is the cause)