Thyroid Storm (Thyrotoxic Crisis)

Overview

• Presented by: Sarah from RegisteredNurseRN.com
• Topics Covered:
  • Definition of thyroid storm
  • Causes
  • Signs and symptoms
  • Nursing interventions
  • Medications
• Part of an endocrine series focusing on the thyroid gland.

Definition

• A life-threatening complication that can develop in people with hyperthyroidism (excessive thyroid hormone production).
• Described as a 'violent storm' on the body, causing accelerated body functions.

Basic Understanding of Thyroid Gland

• Located below the larynx (voice box).
• Butterfly-shaped gland producing hormones T3 and T4.
• Requires iodine for hormone production.
• Functions of T3 and T4:
  • Calorie burning and metabolism regulation
  • Cell replacement rate
  • Food digestion speed
  • Sympathetic nervous system stimulation (alertness, reflexes)
  • Body temperature, heart rate, blood pressure
  • Brain development
  • Regulation of TSH (Thyroid Stimulating Hormone)

Causes of Thyroid Storm

• Untreated or undiagnosed hyperthyroidism
• Inadequate antithyroid hormone treatment
• Severe illness like sepsis or diabetic ketoacidosis
• Stress from surgery, thyroidectomy, or trauma
• Graves’ disease
• Non-compliance with antithyroid hormone medications
• Increased thyroid hormones from medications like aspirin (salicylates)
• Pregnancy
• Radioactive iodine exposure

Signs and Symptoms

• Severe hyperthyroid symptoms:
  • High fever
  • Severe hypertension and tachycardia
  • Potential for myocardial infarction or congestive heart failure
  • Increased respirations leading to potential respiratory failure
  • Restlessness, irritability, confusion, progressing to seizures, delirium, coma
  • Diarrhea due to rapid GI system function

Nursing Interventions

• Monitor:
  • Heart rate, blood pressure, respirations
  • EKG for arrhythmias
  • Temperature
• Ensure a quiet and cool environment
• Use cooling blankets or sedatives if ordered
• Avoid foods high in iodine (seafood, seaweed, dairy, eggs)

Medications

• Anti-thyroid Medications:

  • Methimazole (Tapazole): Fewer side effects but not for use in the first trimester of pregnancy
  • Propylthiouracil (PTU): Safe in first trimester, monitor liver function
  • Watch for agranulocytosis and thrombocytopenia
  • Side effect: potential hypothyroidism

• Iodide Solution (Lugol’s Solution):

  • Blocks secretion of thyroid hormones
  • Side effect: metallic taste

• Fever Management:

  • Use Tylenol, avoid salicylate (increases thyroid hormones)

• Cardiac Medications (Beta Blockers):

  • Example: Inderal
  • Not for patients with asthma or bronchospasm
  • Caution in diabetic patients due to masking hypoglycemia symptoms

• Glucocorticoids:

  • Dexamethasone to suppress the immune system
  • Decreases conversion of thyroid hormones

Conclusion

• For further learning, take the quiz on RegisteredNurseRN.com and explore other related videos on thyroid conditions.
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