Thyroid storm ...

Thyroid storm is

a rare, life-threatening condition

characterized by severe or exaggerated c

linical manifestations of thyrotoxicosis.

-longstanding untreated hyperthyroidism

(Graves' disease, toxic multinodular goiter, solitary toxic adenoma),

- thyroid or nonthyroidal surgery, trauma, infection,

an acute iodine load, or parturition.

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-tachycardia,

-hyperpyrexia,[고열]

-CNS dysfunction (agitation, delirium, psychosis, stupor, or coma),

-gastrointestinal symptoms (nausea, vomiting, abdominal pain)

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Thyroid function tests ; hyperthyroidism

-elevation of free T4 and/or T3

-suppression of TSH

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[initial Tx]

1. beta blocker

(propranolol in a dose to achieve adequate control of heart rate,

typically 60 to 80 mg orally every four to six hours),

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2.thionamide[ anti-thyroid drugs]

1)PTU [200 mg every four hours] or

2)methimazole

-longer half-life

-[20 mg orally every four to six hours]. or

3)Carbimazole

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3.glucocorticoids

-to reduce T4-to-T3 conversion

(hydrocortisone, 100 mg intravenously every eight hours).

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4.Bile acid sequestrants

(cholestyramine, 4 g orally four times daily)

may also be of benefit in severe cases
to decrease enterohepatic recycling of thyroid hormones.

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5. 1 hour after a thionamide is given,

administer iodine

-to block the release of thyroid hormone

1) SSKI,

5 drops [20 drops/mL, 50 mg iodide/drop] orally every six hours,  or

2)Lugol's solution,

10 drops [20 drops/mL, 6.25 mg iodine/drop] every eight hours

--->Tx for 5~7 days