Thyroid Storm (Thyrotoxic Crisis)

Overview

• Presenter: Sarah, Registered Nurse
• Topic: Thyroid Storm (Thyrotoxic Crisis)
• Part of: Endocrine series on thyroid disorders
• Other Topics in Series: Hypo and hyperthyroidism, complications like myxedema coma, Graves' disease
• Resource: Free quiz available on register nurse orient.com

Definition

• A life-threatening complication of hyperthyroidism
• Excessive production of thyroid hormones (T3 and T4)

Role of Thyroid Gland

• Located below the larynx
• Butterfly-shaped gland
• Produces thyroid hormones (T3 and T4)
• Requires iodine for hormone production
• Functions of T3 and T4:
  • Metabolism: Helps burn calories
  • Cell turnover
  • Digestion: Stimulates GI tract
  • Sympathetic Nervous System: Increases alertness
  • Body Temperature: Regulates heat
  • Heart Rate and Blood Pressure
  • Brain Development
  • Regulates: Thyroid Stimulating Hormone (TSH) from anterior pituitary

Causes of Thyroid Storm

• Untreated or undiagnosed hyperthyroidism
• Inadequate treatment or non-compliance with anti-thyroid meds (e.g. Tapazole)
• Stress on the body like severe illness (sepsis, diabetic ketoacidosis)
• Surgical stress or trauma (e.g. thyroidectomy)
• Graves' Disease: Poorly managed
• Medications that increase thyroid hormones (e.g. aspirin)
• Pregnancy
• Radioactive iodine exposure (e.g. CT scans)

Signs and Symptoms

• Severe symptoms of hyperthyroidism:
  • High Fever
  • Hypertension
  • Tachycardia: Risk of myocardial infarction (MI) or congestive heart failure
  • Increased Respirations: Risk of respiratory failure
  • Restlessness and Irritability: Can progress to seizures, delirium, coma
  • Diarrhea: Due to rapid GI transit

Nursing Interventions

• Monitor:
  • Heart rate, blood pressure, respirations
  • Risk of respiratory failure (possible mechanical ventilation)
  • EKG for arrhythmias
  • Temperature
• Environment:
  • Keep quiet and cool
  • Possibly use cooling blankets or sedatives
  • Avoid iodine-rich foods (e.g. seafood, seaweed, dairy, eggs)
• Medication Administration:
  • Decrease thyroid hormone levels
  • Control fever
  • Decrease hormone effects on the body
  • Prevent further hormone secretion

Medications

Anti-Thyroid Medications

• Methimazole (Tapazole)
  • Fewer side effects
  • Not used in the first trimester of pregnancy
• Propylthiouracil (PTU)
  • Safe in the first trimester of pregnancy
  • Monitor for liver failure (check liver enzymes)
• Side Effects:
  • Agranulocytosis, thrombocytopenia
  • Potential for hypothyroidism symptoms

Iodide Solution

• Lugol's Solution: Blocks thyroid hormone secretion
• Side Effects: Metallic taste

Fever Management

• Use Tylenol
• Avoid salicylates (increase thyroid hormones)

Beta Blockers

• Propranolol: Reduces symptoms (tachycardia, hypertension)
• Caution:
  • Asthma, bronchospasm history
  • Diabetic patients (masks hypoglycemia symptoms)

Glucocorticoids

• Dexamethasone: Suppresses immune system to decrease hormone conversion

Conclusion

• Take the quiz on the website for self-assessment
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