Thyroid Storm¶
Gaby Schroeder
Background¶
-
Diagnosis is based on recognition of exaggerated signs/symptoms of thyrotoxicosis leading to multi-organ dysfunction in the setting of precipitating event
-
Common Precipitants: Grave’s Disease, surgery, trauma, pregnancy, stress, infection, MI/PE, medication non-compliance, iodine loads
-
Use Burch-Wartofsky Point Scale (BWPS); available on MD Calc
-
> 45: highly suggestive
-
25-44: impending storm
-
\< Less than 25: unlikely to represent storm
-
Management¶
-
ENDOCRINE EMERGENCY - if suspected consult Endocrine ASAP
-
Therapies directed towards thyroid gland
- PTU: Preferred because it inhibits peripheral conversion of T4 -> T3 as well as production of T4, 500-1000mg loading dose, followed by 250mg q4 -6 hours (PO, rectal)
- Methimazole: q4-6 hours, dose varies (PO, rectal, IV)
-
Therapies directed toward decreasing T4 to T3 conversion
- Propranolol (60-80mg PO q4)
- Hydrocortisone (300mg x1, 100mg q8) - treats high incidence of co-existing adrenal insufficiency
-
Cholestyramine 4g QID can be considered to reduce enteric recirculation
-
Refractory Storm: plasmapheresis and plasma exchange
-
Close hemodynamic monitoring, may need vasopressors (consider transfer to ICU)