Thyrotoxic Crisis

Posted by e-Medical PPT Friday, November 5, 2010
Thyroid storm, also referred to as thyrotoxic crisis, is an acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones in individuals with thyrotoxicosis. The clinical presentation includes fever, tachycardia, hypertension, and neurological and GI abnormalities. Hypertension may be followed by congestive heart failure that is associated with hypotension and shock. The adult mortality rate is extremely high (90%) if early diagnosis is not made and the patient is left untreated. With better control of thyrotoxicosis and early management of thyroid storm, adult mortality rates have declined to less than 20%.
Thyroid storm is most often seen in a thyrotoxic patient with intercurrent illness, trauma or emergency surgery. Common precipitants include:
* Infection or other acute illness
* Withdrawal of or non-compliance with anti-thyroid medication
* Recent trauma, including surgical stress
* Myocardial infarction or stroke
* Diabetic ketoacidosis or hypoglycaemia
* Following childbirth
* Pulmonary embolism
* Drugs: radio-iodine, amiodarone, radiographic contrast media
* Overdose of thyroid hormone tablets
* Recent thyroid surgery

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