Understanding Thyroid Storm and Its Management

Hey everyone, it's Sarah with RegisteredNurseRN.com and in this video I'm going to be going over thyroid storm, also known as thyro-toxin crisis. What I'm going to be doing for you in this video is I'm going to be covering an NCLEX review over the causes, the signs and symptoms, the nursing interventions, and the medications given in this condition. This video is actually part of an endocrine series going over the thyroid. In the previous videos, I covered hypo and hyperthyroidism, and I want to be covering the complications of those in the next videos coming out like myxedema, coma, Graves' disease and things like that. Be sure to check out those videos. After this video, be sure to go to my website, RegisteredNurseRN.com, and take the free quiz that will test your knowledge on thyroid storm. And a card should be popping up so you can access that. So, let's get started. First, let's start out talking about what a thyroid storm is. What is the definition? Well, thyroid storm is a life-threatening complication that can develop in people with hyperthyroidism, which is excessive thyroid hormone production. Before we get into the causes, the signs and symptoms, and the nursing interventions, let's go over the basics because if you can understand the basics, you can understand why this patient looks so sick and why- we're doing these certain interventions for them. Let's talk about the thyroid gland a little bit. The thyroid gland sits below your larynx, which is your voice box where the laryngeal prominence is, right below that. It's a butterfly shaped gland. This gland releases thyroid hormones. Thyroid hormones play a huge role in how your body functions. It produces hormones like T3 and T4. The thyroid gland cannot produce thyroid hormones without iodine. Very important to remember this. So we consume iodine in the foods we eat. Like here in the U.S., our table salt, it has iodine in it. So we tend to have okay issues with iodine levels, but if you get too much iodine, you're going to be producing way too much thyroid hormones, T3 and T4. So you're going to enter into hyperthyroidism, but if you're not getting enough iodine, your body can't make T3 and T4. So you can enter into hypothyroidism. What does T3 and T4 do? T3 and T4 functions to allow us to burn calories. It helps with our metabolism rate. It also helps determine how fast we replace new cells with dying ones, how fast we digest our food, it stimulates our sympathetic nervous system which helps us stay alert, our responses, our reflexes. It also plays a role in increasing our body temperature, our heart rate, our blood pressure, brain development and regulates TSH. TSH is a thyroid stimulating hormone released by your anterior pituitary gland and whenever it's released it stimulates T3 and T4 production. If you have way too much T3 and T4 like how you do in this condition, you will have crazy things going on. Your body is going to be working at an accelerated rate. What I like to say, what's going on with this condition is that it's literally like a violent storm. on your body at an accelerated rate, hence the name thyroid storm. So remember that because a lot of people get this condition confused with myxedema coma, which is a complication of hypothyroidism. So just remember this condition as a violent storm on your body. And whenever thunderstorm storms come, they're violent, they're fast, they're accelerated. And that is what is going on in this condition. So what causes it? Okay, one thing is untreated or undiagnosed hyperthyroidism. Maybe they're taking their antithyroid hormone like tapasol, but it's not enough and they go enter into this because it didn't help correct the levels or they didn't even know they had it or they're not taking it. Another thing is a person with hyperthyroidism, if they get severely sick, like they get septic or they go in diabetic ketoacidosis because they're diabetic, they can enter into this. Any type of stress on the body like like surgery, thyroidectomy, anything like that, or trauma to the thyroid gland can cause this condition. Also, people with Graves' disease, which is a condition we'll be talking about in another video, they are more susceptible to this. It's usually because it's not being treated correctly or they've got sick. Like I said, not taking their anti-thyroid hormones properly, they're not compliant with it or they're taking a lot of medications that actually increase thyroid. hormones like aspirin, those salicylates, they increase thyroid hormones. Pregnancy, being pregnant, pregnancy causes craziness to go on in your body and that can you into this or a radioactive iodine remember what I said at the beginning your thyroid gland loves iodine so say they got a CT scan where they got this or they were getting treatment this can throw them into a thyroid storm so how is your patient going to look? What are those big signs and symptoms that you need to know for NCLEX in case you get a question about this? Okay, typically they're going to have those typical hyperthyroid signs and symptoms but they are going to be severe. The reason they're severe is because the body has all these excessive hormones going on and it's wired. It's so wired where everything's going to be working at an accelerated rate that your body can only do that for so long. It's going to become exhausted and wear out and quit working to the point of death. So what are they going to have? Instead of just having heat intolerance like you do in hyperthyroidism, they're going to have a high fever. They're going to have hypertension and tachycardia. to the point where that blood is pumping so hard and so fast they might have a myocardial infarction, an MI, or go into congestive heart failure because that heart muscle is just exhausted and can't tolerate anymore. So they can enter into that if this is not corrected. They're going to have increased respirations. Why? Think back. Why are they going to be breathing at a rapid rate? Because the body is working at full speed of head and it's working so hard and so fast that it needs more nutrients, more oxygen. So it's increasing those respirations to give your body what it needs. But this progresses to respiratory failure. They're going to be very restless, irritable, confused, which will progress to seizures, delirium, eventually a coma. And they will have diarrhea. Because remember, T3 and T4 plays a role in how fast your GI system digests food and food is going to be flying through there. So what are the nursing interventions? What are you going to do for this patient as a nurse? Well, I'm going to cover our nursing interventions and then I'm going to go over the medication. and side effects and things you need to watch out for. Okay, what you want to do is you want to monitor their heart rate, their blood pressure, their respirations because these people are really at risk for respiratory failure. They're probably going to be on mechanical ventilation so you want to make sure you've got a patent airway. Watch their EKG because they're at risk for arrhythmias and definitely monitor their temperature. Another thing you want to do is keep the environment quiet and cool because they are stimulated. You may, if the doctor has ordered it, start them on some cooling blankets to keep them nice and cool or a sedative to help keep them calm and Absolutely, no foods with iodine again foods high in iodine Iodine or like your seafood foods found in the sea like seaweed which is also known as kelp kelp and dairy and eggs Now another big role as a nurse what you're gonna be doing is you're gonna be in administering medications and the goal of these medications of course is to decrease that thyroid hormone hormone level. You want to decrease that fever. You don't want them to be in hyperthermia. You also want to give meds that are going to decrease the effects of the hormones on the body and you're going to give some meds that are going to decrease further secretion and conversion of the thyroid hormone. So let's look at those medications. Our first goal is to decrease the thyroid hormone because remember in thyroid storm they have crazy amounts of thyroid hormone that is literally killing the person to the point of death. So what we want to give first are anti-thyroid medications and what they do is that they block the synthesis of thyroid hormone and these medications include tapazole also known as methamazole and PTU which is called propothyreuracil. They'll use either one of those. With methamazole there's fewer side effects however you cannot use this medication in the first trimester of pregnancy. But with PTU, you can use that in the first trimester of pregnancy. So commit that to memory. PTU, okay first trimester, methamazole is not. However with PTU, you have to watch liver function. It is known to cause liver failure, so watch those liver enzymes. Now main side effects that a person can have that's dangerous with these two medications is that you need to watch for agranulocytosis and thrombocytopenia. Also watch Watch for signs and symptoms of hypothyroidism. Another type of medication given is iodide solution also known as Lugol solution and this works to block the The secretion of thyroid hormones. So anti-thyroid medications block the synthesis, iodine solution blocks the secretion. The side effects of this are taste changes like a metal taste in the mouth. Our next goal is to decrease the fever because they're hyperthermic. So Tylenol, remember you're not going to give any psilocylate because that increases thyroid hormones. So we're going to make an option that it's not psilocylate. Our other goal is to decrease the effects of the thyroid hormone on the body by blocking peripheral conversion of T3 and T4. What medications do that? What medications are going to stop and help the patient have some relief from that? All those symptoms of tachycardia, hypertension, some cardiac meds known as beta blockers, popular one, Enderal. However, remember with beta blockers, we talked about this in the hypertension NCLEX review video. Do not give these to patients who have a history of asthma or bronchospasm because we can exacerbate that. Also, diabetics, if it's a diabetic patient that you're giving this to, you want to watch out for masking signs of hypoglycemia because if a diabetic takes a beta blocker, normally if they had signs and symptoms of whenever their sugar is falling, they may not get those typical signs and symptoms like the tachycardia, the sweating because this will block it. So watch out for that. And last but not least, we've got some really good news. We want to prevent, another goal is preventing the secretion and conversion of a thyroid hormone by suppressing the immune system. So sometimes the physician will order glucocorticoids like dexamethasone to help suppress the immune system so you can further decrease the conversion of the thyroid hormone. So that is about thyroid storm. Now go take that free quiz on my website, registerinurseorin.com and be sure to check out the other videos in this series about the thyroid. And thank you. you so much for watching and please consider subscribing to this YouTube channel.

Be sure to check out those videos. After this video, be sure to go to my website, RegisteredNurseRN.com, and take the free quiz that will test your knowledge on thyroid storm. And a card should be popping up so you can access that. So, let's get started.

First, let's start out talking about what a thyroid storm is. What is the definition? Well, thyroid storm is a life-threatening complication that can develop in people with hyperthyroidism, which is excessive thyroid hormone production. Before we get into the causes, the signs and symptoms, and the nursing interventions, let's go over the basics because if you can understand the basics, you can understand why this patient looks so sick and why- we're doing these certain interventions for them.

Let's talk about the thyroid gland a little bit. The thyroid gland sits below your larynx, which is your voice box where the laryngeal prominence is, right below that. It's a butterfly shaped gland. This gland releases thyroid hormones. Thyroid hormones play a huge role in how your body functions.

It produces hormones like T3 and T4. The thyroid gland cannot produce thyroid hormones without iodine. Very important to remember this. So we consume iodine in the foods we eat.

Like here in the U.S., our table salt, it has iodine in it. So we tend to have okay issues with iodine levels, but if you get too much iodine, you're going to be producing way too much thyroid hormones, T3 and T4. So you're going to enter into hyperthyroidism, but if you're not getting enough iodine, your body can't make T3 and T4.

So you can enter into hypothyroidism. What does T3 and T4 do? T3 and T4 functions to allow us to burn calories.

It helps with our metabolism rate. It also helps determine how fast we replace new cells with dying ones, how fast we digest our food, it stimulates our sympathetic nervous system which helps us stay alert, our responses, our reflexes. It also plays a role in increasing our body temperature, our heart rate, our blood pressure, brain development and regulates TSH. TSH is a thyroid stimulating hormone released by your anterior pituitary gland and whenever it's released it stimulates T3 and T4 production.

If you have way too much T3 and T4 like how you do in this condition, you will have crazy things going on. Your body is going to be working at an accelerated rate. What I like to say, what's going on with this condition is that it's literally like a violent storm. on your body at an accelerated rate, hence the name thyroid storm.

So remember that because a lot of people get this condition confused with myxedema coma, which is a complication of hypothyroidism. So just remember this condition as a violent storm on your body. And whenever thunderstorm storms come, they're violent, they're fast, they're accelerated.

And that is what is going on in this condition. So what causes it? Okay, one thing is untreated or undiagnosed hyperthyroidism. Maybe they're taking their antithyroid hormone like tapasol, but it's not enough and they go enter into this because it didn't help correct the levels or they didn't even know they had it or they're not taking it. Another thing is a person with hyperthyroidism, if they get severely sick, like they get septic or they go in diabetic ketoacidosis because they're diabetic, they can enter into this.

Any type of stress on the body like like surgery, thyroidectomy, anything like that, or trauma to the thyroid gland can cause this condition. Also, people with Graves' disease, which is a condition we'll be talking about in another video, they are more susceptible to this. It's usually because it's not being treated correctly or they've got sick.

Like I said, not taking their anti-thyroid hormones properly, they're not compliant with it or they're taking a lot of medications that actually increase thyroid. hormones like aspirin, those salicylates, they increase thyroid hormones. Pregnancy, being pregnant, pregnancy causes craziness to go on in your body and that can you into this or a radioactive iodine remember what I said at the beginning your thyroid gland loves iodine so say they got a CT scan where they got this or they were getting treatment this can throw them into a thyroid storm so how is your patient going to look? What are those big signs and symptoms that you need to know for NCLEX in case you get a question about this?

Okay, typically they're going to have those typical hyperthyroid signs and symptoms but they are going to be severe. The reason they're severe is because the body has all these excessive hormones going on and it's wired. It's so wired where everything's going to be working at an accelerated rate that your body can only do that for so long. It's going to become exhausted and wear out and quit working to the point of death.

So what are they going to have? Instead of just having heat intolerance like you do in hyperthyroidism, they're going to have a high fever. They're going to have hypertension and tachycardia. to the point where that blood is pumping so hard and so fast they might have a myocardial infarction, an MI, or go into congestive heart failure because that heart muscle is just exhausted and can't tolerate anymore.

So they can enter into that if this is not corrected. They're going to have increased respirations. Why? Think back. Why are they going to be breathing at a rapid rate?

Because the body is working at full speed of head and it's working so hard and so fast that it needs more nutrients, more oxygen. So it's increasing those respirations to give your body what it needs. But this progresses to respiratory failure.

They're going to be very restless, irritable, confused, which will progress to seizures, delirium, eventually a coma. And they will have diarrhea. Because remember, T3 and T4 plays a role in how fast your GI system digests food and food is going to be flying through there. So what are the nursing interventions? What are you going to do for this patient as a nurse?

Well, I'm going to cover our nursing interventions and then I'm going to go over the medication. and side effects and things you need to watch out for. Okay, what you want to do is you want to monitor their heart rate, their blood pressure, their respirations because these people are really at risk for respiratory failure.

They're probably going to be on mechanical ventilation so you want to make sure you've got a patent airway. Watch their EKG because they're at risk for arrhythmias and definitely monitor their temperature. Another thing you want to do is keep the environment quiet and cool because they are stimulated. You may, if the doctor has ordered it, start them on some cooling blankets to keep them nice and cool or a sedative to help keep them calm and Absolutely, no foods with iodine again foods high in iodine Iodine or like your seafood foods found in the sea like seaweed which is also known as kelp kelp and dairy and eggs Now another big role as a nurse what you're gonna be doing is you're gonna be in administering medications and the goal of these medications of course is to decrease that thyroid hormone hormone level. You want to decrease that fever.

You don't want them to be in hyperthermia. You also want to give meds that are going to decrease the effects of the hormones on the body and you're going to give some meds that are going to decrease further secretion and conversion of the thyroid hormone. So let's look at those medications.

Our first goal is to decrease the thyroid hormone because remember in thyroid storm they have crazy amounts of thyroid hormone that is literally killing the person to the point of death. So what we want to give first are anti-thyroid medications and what they do is that they block the synthesis of thyroid hormone and these medications include tapazole also known as methamazole and PTU which is called propothyreuracil. They'll use either one of those.

With methamazole there's fewer side effects however you cannot use this medication in the first trimester of pregnancy. But with PTU, you can use that in the first trimester of pregnancy. So commit that to memory. PTU, okay first trimester, methamazole is not.

However with PTU, you have to watch liver function. It is known to cause liver failure, so watch those liver enzymes. Now main side effects that a person can have that's dangerous with these two medications is that you need to watch for agranulocytosis and thrombocytopenia. Also watch Watch for signs and symptoms of hypothyroidism.

Another type of medication given is iodide solution also known as Lugol solution and this works to block the The secretion of thyroid hormones. So anti-thyroid medications block the synthesis, iodine solution blocks the secretion. The side effects of this are taste changes like a metal taste in the mouth.

Our next goal is to decrease the fever because they're hyperthermic. So Tylenol, remember you're not going to give any psilocylate because that increases thyroid hormones. So we're going to make an option that it's not psilocylate. Our other goal is to decrease the effects of the thyroid hormone on the body by blocking peripheral conversion of T3 and T4. What medications do that?

What medications are going to stop and help the patient have some relief from that? All those symptoms of tachycardia, hypertension, some cardiac meds known as beta blockers, popular one, Enderal. However, remember with beta blockers, we talked about this in the hypertension NCLEX review video. Do not give these to patients who have a history of asthma or bronchospasm because we can exacerbate that. Also, diabetics, if it's a diabetic patient that you're giving this to, you want to watch out for masking signs of hypoglycemia because if a diabetic takes a beta blocker, normally if they had signs and symptoms of whenever their sugar is falling, they may not get those typical signs and symptoms like the tachycardia, the sweating because this will block it.

So watch out for that. And last but not least, we've got some really good news. We want to prevent, another goal is preventing the secretion and conversion of a thyroid hormone by suppressing the immune system. So sometimes the physician will order glucocorticoids like dexamethasone to help suppress the immune system so you can further decrease the conversion of the thyroid hormone.

So that is about thyroid storm. Now go take that free quiz on my website, registerinurseorin.com and be sure to check out the other videos in this series about the thyroid. And thank you. you so much for watching and please consider subscribing to this YouTube channel.

Transcript for:Understanding Thyroid Storm and Its Management

Transcript for:
Understanding Thyroid Storm and Its Management