Thyrotoxic storm sx
fever over 103, sweaty and heat intol, exophthalmos, HR over 140, hyperT then hypoT, a-fib/flutter, HF, n/v, agitation, tremor, audible bruit, psychosis, insomnia, stupor, coma, death w/i 48h
Causes of thyrotoxic storm
Excess T3/4, thyroid adenoma, subacute thyroiditis, toxic multinodular goiter, excessive iodine ingestion (Jod-Basedow Syndrome), excessive thyroid hormone replacement
Graves storm patho
thyroid stimulating antibodies bind to receptors -> tell T4 to convert to T3 -> cause gland to enlarge -> negative feedback decreases TSH but the thyroid doesn’t listen
Thyrotoxic storm meds
- Propranolol q6h
- PTU (prevent synth of T4-T3) q4h
- iodine after PTU
- Glucocorticoids q8h
- bile acid sequestrans to dec thy hor levels q6h
glucocorticoids for thyrotoxic storm
- dec T3 and T4 conversion, promote vasomotor stability, may tx assoc adrenal insuff
- does not affect mort
- only for clear evidence of thy storm
Bile acid sequestrant MOA
- interfere with enterohepatic circ (bile acid prod in liver to abs in sm int)
- thy hor metab in liver, released and reabs in intestines, excreted in bile
rf for thyrtoxic storm
- Surgery, trauma, infection
- Long-standing untreated thyroid disease with precipitating event that may/may not involve thyroid
- Irregular or abrupt d/c of thyroid drugs
- fam hx, >40, F, white, meds (amiodarone), increased Iodine intake, preg (hormones similar to TSH)
myxedema coma s/s
- Decreased mental status, hypotherm (predicts death), slow function of organs
- decreased mental status (coma)
- hypoT, bradycardia, hypogly, hypovent (resp acidosis)
- hypoNa: mental change, dilutional bc H2O excreted
patho of myxedema coma
- Med emergency with high mortality rate, but uncommon due to earlier diagnosing capabilities
- severe long term hypothyroid
when are meds begun for myxedema coma
ASAP w/o lab results
Meds for myxedema coma
- T3 and T4 for slow bolus then daily (combo best)
- IV glucocorticoids until adrenal insuff fixed (q8h)
- supportive—ICU, IVF, electros, mech vent, gluc, hypotherm, treat underlying infx
Priority for myxedema tx
hypotherm
rf for myxedema
- Severe, long-term hypothyroid w/ precipitating event (infx, MI, extreme cold, surg)
- Sedatives like opioids
Addisonian crisis sx
- sudden pain in lower back, abd, legs from hypoNa
- severe v/d, dehyd, hypoT, hyperK, hypoNa
- salt crave
- dec LOC, conf, slur
Patho of addisonian crisi
sudden insuff of corticosteroids
Meds for addisonian crisi
- IV hydrocortisone 100mg IV bolus then 50mg q6h (taper to maintenance and PO when able)
- 1-3L NS and 5% dextrose for energy
rf for Addisonian crisi
Primary adrenal insuff
Hashimoto’s patho
antibodies attack thyroid;
thyroid receptor antibodies, antithyroglobulin antibody
- Hallmark of disorder: antithyroperoxidase antibody
