Thanks to Dr. Kopping for today’s Morning Report!
THYROID STORM
Thyrotoxicosis represents anywhere from 0.05% to 1.3%
- Storm represents <10% of hospitalized
- However untreated 80 to 100% mortality
- Drops to 20 to 30% with treatment
What makes the difference from thyrotoxicosis to thyroid storm?
- Comparable levels
- Precipitating factors- some sort of physiologic stressor
- Infection(most common)
- Trauma, MI, CVA, PE, DKA, surgery (particularly thyroid), Iodine administration(dye, amiodoarone), abruptly stopping antithyroid meds
- Adrenergic hyperactivity- release from binding sites or increase binding site sensitivity
- Cause a lot of biochemical changes downstream that is beyond my capacity
When is it thyroid storm?
- Burch & Wartofsky Diagnostic Criteria (http://wikem.org/wiki/Thyroid_Storm)
5 Step Treatment Approach
- Supportive care- IV, fever control, nutrition (dextrose, multivitamin, thiamine, folate), O2 as needed, cardiac monitoring
- Inhibition of thyroid release- PTU (preferred) or methimazole
- Inhibition of NEW thyroid release MUST be done AT LEAST 1 hour after (ie Lugol solution, potassium iodide, IV iopanoic acid, Iopdate, Lithium carbonate
- B adrenergic receptor blockade (propranolol, esmolol, rerpine/guanethidine if BB contraindicated)
- Prevent peripheral conversion (Hydrocortisone or dexamethasone)
Above all else…
FIND AND TREAT THE PRECIPITATING EVENT!!
References:
http://accessmedicine.mhmedical.com.newproxy.downstate.edu/ViewLarge.aspx?figid=40403707
Nayak, B; Burman, K “Thyrotoxicosis and Thyroid Storm”
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Jay Khadpe MD
- Editor in Chief of "The Original Kings of County"
- Assistant Professor of Emergency Medicine
- Assistant Residency Director
- SUNY Downstate / Kings County Hospital
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