Thyroidism

Question 1

thyroid storm

Answer 1

Due to hyperthyroidism
Intense stimulus on metabolism

Life-threatening condition from surgery, infection, trauma

Question 2

risk factors for thyroid storm

Answer 2

Long-standing, hyper thyroidism – Graves’ disease
Acute event
Irregular use/discontinuation of thyroid drugs

Question 3

s/sx thyroid storm

Answer 3

Fever – greater than 103
Heart rate greater than 140
Intolerance to heat
Agitation
N/V
Tremor, psychosis
Stupor, coma
Hypotension

Question 4

treatment for thyroid storm

Answer 4

Beta blocker – increase adrenergic tone Q6 hours

thionamide– block hormone synthesis from T4 to T3 Q4 hours

Iodine solution – block release of thyroid hormone

Glucocorticoids – decrease T3 to T4, promote, vasomotor, stability, relative adrenal insufficiency, Q8 hours

Bile acid sequestrant – decrease hepatic circulation and recycling of thyroid hormone Q6 hours

Question 5

myxedema crisis

Answer 5

Severe hypothyroidism
Medical emergency

Question 6

risk factors for myxedema crisis

Answer 6

Hypothyroidism – long-standing, untreated
Acute event with poorly controlled hypo, due to-infection, MI, cold exposure, seizure
Administration of sedative drugs – opioids

Question 7

s/sx myxedema crisis

Answer 7

Decreased mental status, coma
Hypothermia
Hypotension
Bradycardia
Hyponatremia
Hypoglycemia
Hypoventilation – respiratory acidosis

Question 8

Treatment for myxedema crisis

Answer 8

thyroid hormone – levothyroxine, liothyronine (IV, slow bolus)

glucocorticoids – IV Q8 hours

supportive – ICU, IVF, electrolyte replacement, mechanical ventilation, glucose monitoring, correction of hypothermia