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Thyroid Storm

- Discussion: 
   - look for fever, severe tachycardia, dehydration, & mental abnormalities;
   - thyroid storm is rare and precipitated by infection, trauma, surgery, labor and delivery, or radiation thyroiditis; dz procedes to death; 
- Treatment: 
   - immediate therapuetic approach: propanolol;
   - propanolol also blocks the conversion of T4-to- T3; 
   - will blunt the peripheral manifestations of thyrotoxicosis, such as tachycardia, tremor, irritability, excessive sweating, and lid retraction; 
   - begin w/: 10-20mg PO q6hr and dosage is increased til control of symptoms (tachycardia) achieved; 
   - usually daily dose of 80-320mg or even higher; 
   - fluids, electrolytes, vasopressor agents, glucose given to prevent Hypoglycemia
   - acetaminophren & cooling blanket for fever; 
   - in refractory cases try chlorpromazine: 25-50mg PO/IM q6hr; 
   - consider: 
   - propylthiouracil (PTU): 300-400mg PO given initially, followed by 200mg PO q4hr; 
   - methimazole 30-40mg PO given initially, then 20-30 mg PO q8hr; 
   - iodine: (not effective for long term management, but also used acutely for non-storm conditions; interferes w/ thyroid hormone release and synthesis (Wolff Chaikoff effect); SSKI: 1-5 drops (1-2drops=50-100mg); 
   - Steroids: Dexamethasone 
   - 2mg PO/IV q6hr; 
   - inhibits thyroid hormone secretion and peripheral conversion