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Once thyroid storm is
recognized the patient should be managed in an appropriate location such as an
Acute Medical Unit (AMU), high-dependency area or intensive care unit.
Once
thyroid storm is recognized the patient should be managed in an appropriate
location such as an Acute Medical Unit (AMU), high-dependency area or intensive
care unit.
Thyroid
storm (also known as thyroid or thyrotoxic crisis) represents the severe end of
the spectrum of thyrotoxicosis and is characterized by compromised organ
function. Whilst rare in the modern era, the mortality rate remains high, and
prompt consideration of this endocrine emergency, with specific treatments, can
improve outcomes.
The
therapeutic options for thyroid storm are the same as those for uncomplicated
thyrotoxicosis, except that the drugs are given in higher doses and more
frequently. When treating thyroid storm, one should consider the five ‘Bs’:
Block synthesis (i.e. anti thyroid drugs); Block release (i.e. iodine);
Block T4 into T3 conversion (i.e. high-dose propylthiouracil [PTU],
propranolol, corticosteroid and, rarely, amiodarone); Beta-blocker; and Block
enterohepatic circulation (i.e. cholestyramine).
Supportive
care includes cooling measures, appropriate intravenous (IV) fluid
resuscitation, electrolyte replacement and nutritional support. Antipyretics
can be administered to relieve the distress of profound pyrexia, but salicylates
(e.g. aspirin) should be avoided as they are associated with displacement of
thyroid hormone binding from thyroid binding globulin (TBG)
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