- Discussion:
- look for fever, severe tachycardia, dehydration, & mental abnormalities;
- thyroid storm is rare and precipitated by infection, trauma, surgery, labor and delivery, or radiation thyroiditis; dz procedes to death;
- Treatment:
- immediate therapuetic approach: propanolol;
- propanolol also blocks the conversion of T4-to- T3;
- will blunt the peripheral manifestations of thyrotoxicosis, such as tachycardia, tremor, irritability, excessive sweating, and lid retraction;
- begin w/: 10-20mg PO q6hr and dosage is increased til control of symptoms (tachycardia) achieved;
- usually daily dose of 80-320mg or even higher;
- fluids, electrolytes, vasopressor agents, glucose given to prevent Hypoglycemia;
- acetaminophren & cooling blanket for fever;
- in refractory cases try chlorpromazine: 25-50mg PO/IM q6hr;
- consider:
- propylthiouracil (PTU): 300-400mg PO given initially, followed by 200mg PO q4hr;
- methimazole 30-40mg PO given initially, then 20-30 mg PO q8hr;
- iodine: (not effective for long term management, but also used acutely for non-storm conditions; interferes w/ thyroid hormone release and synthesis (Wolff Chaikoff effect); SSKI: 1-5 drops (1-2drops=50-100mg);
- Steroids: Dexamethasone
- 2mg PO/IV q6hr;
- inhibits thyroid hormone secretion and peripheral conversion