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Thyroid Storm. Thyroid Storm. Thyroid storm (also know as thyrotoxic crisis) is an acute state of hyperthyroidism where all of the signs and symptoms are exaggerated. It can be life threatening but with quick response can be controlled and managed. Triggers. Trauma Infection Surgery.

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thyroid storm1
Thyroid Storm
  • Thyroid storm (also know as thyrotoxic crisis) is an acute state of hyperthyroidism where all of the signs and symptoms are exaggerated.
  • It can be life threatening but with quick response can be controlled and managed
triggers
Triggers
  • Trauma
  • Infection
  • Surgery
thyroid storm2
Thyroid Storm
  • Treatment is largely symptomatic and etiology dependent
  • Look back at the treatments in your hyperthyroid module
  • Think also about the body’s functioning and the exaggerated symptoms of hyperthyroidism that would be manifested during thyroid storm
storm treatments
Storm Treatments

Treatments directed at thyroid gland and hormones

  • Inhibition of new hormone synthesis with Thioamide drugs such as PTU and methimazole
  • Inhibition of hormone release with Iodine & potassium iodide (Lugol’s solution) & Lithium carbonate
what the heck is lugol s solution
What the heck is Lugol’s solution?
  • Also known as Lugol’s iodine, this oral solution is specifically indicated for patient’s with thyroid storm or preoperatively for a patient with hyperthyroidism
  • It is a mix of iodine, potassium iodide and distilled water
  • It is also used to enhance color and growth for coral in home aquariums!
storm treatments1
Storm Treatments

Treatments directed at preventing hormone’s affects on the body

  • Polythiouracil (PTU)
  • Corticosteroids
  • Beta blockers (most importantly Propanolol)
  • Amiodarone
  • Plasmapheresis
storm treatments2
Storm Treatments

Treatments directed at maintaining homeostasis

  • Hyperthermia: acetaminophen, cooling blankets
  • Fluid and electrolyte testing/replacement
  • Glucose
  • Vasopressors
  • Digoxin & diuretics if appropriate
treatment summary
Treatment Summary

Overall Goal: Reduce circulation thyroid levels and control symptom

  • Beta blockers; decreases adrenergic hyperactivity (sympathetic outflow)
  • PTU (large amounts): prevents synthesis of the hormone
  • Glucocorticoids: inhibit hormone production and decrease peripheral conversion from T4 to T3.
  • Sodium iodide solution (Lugol’s solution): High levels of iodide will initially suppress release of thyroid hormone
  • Treat cardiac symptoms, fever and hypertension
nursing functions
Nursing Functions
  • Initiate cardiac monitoring, have code supplies ready if cardiac symptoms worsen
  • Monitor hemodynamic, respiratory & thermic parameters to ensure that therapies are working (homeostasis)
  • Keep patient safe and re-orient if acutely confused or highly anxious
  • Identify trigger and treat/remove