| disease | Thyroid Storm |
Thyroid storm is a series of manifestations that occur when the condition of a patient with hyperthyroidism worsens.
bubble_chart Etiology
The main contributing factors are: (1) mental stimulation; (2) infection; (3) arbitrary discontinuation of medication; (4) failure to adequately prepare before surgery or radioactive iodine therapy. This condition can be life-threatening, with an extremely high mortality rate, and must be prevented and treated early.
In the early stage of the disease, the patient's original symptoms worsen, accompanied by moderate fever, rapid weight loss, nausea, and vomiting. Later, the fever may reach 40°C or higher, with tachycardia often exceeding 160 beats per minute, profuse sweating, abdominal pain, diarrhea, and even delirium and unconsciousness. The causes of death are mostly due to hyperthermic exhaustion, heart failure, pulmonary edema, and disturbances in water and electrolyte metabolism. Laboratory findings are similar to those of general hyperthyroidism, with a more pronounced increase in T3. Additionally, peripheral blood leukocytes are elevated, especially the neutrophil count. Liver and kidney function may be abnormal.
bubble_chart Treatment Measures
(1) Rapidly reduce the release and synthesis of thyroid hormones: Propylthiouracil is the first choice, administered orally or via gastric tube at 200–300 mg every 6 hours. If methylthiouracil is used, the dose is the same. For methimazole or carbimazole, administer 20–30 mg every 6 hours. The medication typically begins to take effect within 1 hour after administration.
Within 1 hour after antithyroid drug treatment, administer a large amount of iodine solution intravenously or orally to block hormone secretion. Add 0.25 g of sodium iodide solution to 500 ml of 10% glucose solution for intravenous drip every 8–12 hours. Alternatively, administer approximately 30 drops of compound iodine solution orally daily and gradually discontinue it within 2 weeks.
(2) Rapidly block catecholamine release: Administer propranolol 10–40 mg orally every 4–6 hours or 0.5–1 mg intravenously. Monitor cardiac function during medication, especially in elderly patients. It is contraindicated in patients with asthma. Alternatively, administer reserpine 1–2.5 mg intramuscularly every 4–6 hours, or guanethidine orally at 1–2 mg/kg per day.(3) Administer hydrocortisone 200–500 mg/day intravenously to correct relative adrenal insufficiency during the crisis, then gradually reduce the dose to prevent rebound.
(4) Remove precipitating factors: Administer antibiotics for infections.
(5) Supportive and symptomatic treatment: For high fever, use antipyretics (e.g., chlorpromazine) or physical cooling methods (e.g., alcohol sponge baths). Provide oxygen for hypoxia, along with high doses of vitamins, especially B vitamins. Correct typical edema, electrolyte imbalances, and heart failure, among other conditions.
