SAQ 214 – Endocrinology – thyroid storm
Model Answer
Question 3. thyroid storm.
a. Diagnostic features
- Biochemical hyperthyroidism: elevated T4 with or without elevated T3 and suppressed TSH.
- Temperature at least 37.8 C.
- Altered mental state.
- Cardiovascular dysfunction, such as tachycardia disproportionate to fever.
b. Precipitants
- Undiagnosed or undertreated Graves disease.
- Withdrawal of antithyroid medication.
- Infection.
- Acute myocardial infarction.
- Diabetic ketoacidosis.
- Surgery, iodine administration, or thyroxine toxicity.
c. Medications
| Medication | Reason |
|---|---|
| Propranolol. | Controls adrenergic symptoms and reduces peripheral T4-to-T3 conversion. |
| Thionamide. | Blocks new thyroid-hormone synthesis. |
| Iodinated radiocontrast agent. | Inhibits peripheral T4-to-T3 conversion. |
| Glucocorticoid. | Reduces T4-to-T3 conversion and treats possible relative adrenal insufficiency. |
| Bile-acid sequestrant. | Decreases enterohepatic recycling of thyroid hormones. |
d. Contraindicated medication
- Aspirin, because it displaces thyroid hormone from binding proteins.
e. Non-medicinal treatments
- External cooling.
- DC cardioversion for arrhythmia.
- Peritoneal dialysis.
- Plasmapheresis.
- Charcoal haemoperfusion.
Comments are closed for this SAQ.