Transcript Emergency Care: Thyroid Storm and Addisonian Crisis

Thyroid Storm
Thyroid Storm
 Thyroid storm (also know as thyrotoxic
crisis) is an acute state of hyperthyroidism
where all of the signs and symptoms are
exaggerated.
 It can be life threatening but with quick
response can be controlled and managed
Triggers
 Trauma
 Infection
 Surgery
Thyroid Storm
 Treatment is largely symptomatic and
etiology dependent
 Look back at the treatments in your
hyperthyroid module
 Think also about the body’s functioning
and the exaggerated symptoms of
hyperthyroidism that would be manifested
during thyroid storm
Storm Treatments
Treatments directed at thyroid gland and
hormones
 Inhibition of new hormone synthesis with
Thioamide drugs such as PTU and
methimazole
 Inhibition of hormone release with Iodine &
potassium iodide (Lugol’s solution) &
Lithium carbonate
What the heck is Lugol’s solution?
 Also known as Lugol’s iodine, this oral
solution is specifically indicated for
patient’s with thyroid storm or
preoperatively for a patient with
hyperthyroidism
 It is a mix of iodine, potassium iodide and
distilled water
It is also used to enhance
color and growth for coral in
home aquariums!
Storm Treatments
Treatments directed at preventing
hormone’s affects on the body
 Polythiouracil (PTU)
 Corticosteroids
 Beta blockers (most importantly
Propanolol)
 Amiodarone
 Plasmapheresis
Storm Treatments
Treatments directed at maintaining
homeostasis
 Hyperthermia: acetaminophen, cooling
blankets
 Fluid and electrolyte testing/replacement
 Glucose
 Vasopressors
 Digoxin & diuretics if appropriate
Treatment Summary
Overall Goal: Reduce circulation thyroid levels and
control symptom
 Beta blockers; decreases adrenergic
hyperactivity (sympathetic outflow)
 PTU (large amounts): prevents synthesis of
the hormone
 Glucocorticoids: inhibit hormone production
and decrease peripheral conversion from T4
to T3.
 Sodium iodide solution (Lugol’s solution):
High levels of iodide will initially suppress
release of thyroid hormone
 Treat cardiac symptoms, fever and
hypertension
Nursing Functions
 Initiate cardiac monitoring, have code
supplies ready if cardiac symptoms
worsen
 Monitor hemodynamic, respiratory &
thermic parameters to ensure that
therapies are working (homeostasis)
 Keep patient safe and re-orient if acutely
confused or highly anxious
 Identify trigger and treat/remove