Question: Describe the management of the patient presenting with thyroid storm in comparison to myxedema coma. Thyroid Storm - Primary goal of treatment is to correct underlying cause of over production of hormones that are stimulating a high metabolism. Need Assignment Help?
1. Signs and Symptoms a. Tachycardia > 140, congestive heart failure, hypotension, cardiac arrhythmia (a- fib), death. b. Hyperpyrexia temp > 104 up to 106 c. Hyperactivity/Hyperreflexia d. Agitation, anxiety, delirium, psychosis -> stupor/coma i. Risk of death increases as s/s transition for agitation ->coma e. Goiter, ophthalmopathy, lid lag, tremor, warm/moist skin
2. Treatment a. ICU admission b. Beta blocker to counteract increase adrenergic tone i. Propranolol 40-80 mg PO Q4 hours c. Anti-thyroidal drugs - block new hormone synthesis i. Propylthiouracil - load 600 mg PO or PR once then 200-300 mg Q6 hours PO/PR ii. OR iii. Methimazole 20 mg PO Q6 hours d. After anti-thyroidal drugs given - iodine solutions to block the release of thyroid hormone i. Saturated solution of potassium iodide 5 drops Q6 hours e. Glucocorticoids to inhibit conversion of T4 -T3, increase vascular stability, maybe treat adrenal insufficiency if present i. Hydrocortisone 100 mg Q8 hours IV f. Cooling measures g. IV fluids - support b/p h. Oxygen - increased oxygen consumption with hypermetabolic state. i. Treat underlying cause j. Plasmapheresis - filter out thyroid hormone, cytokines, and putative antibodies i. Only after above interventions fail