Thyroid storm, or thyrotoxic crisis, is a life-threatening complication of hyperthyroidism characterized by multisystem involvement. It occurs when a precipitating event causes a sudden increase in thyroid hormone levels in a patient with hyperthyroidism. Common precipitants include discontinuing antithyroid medication or thyroid surgery. Thyroid storm requires prompt treatment with beta-blockers, antithyroid drugs, iodine, glucocorticoids, and supportive care to reduce mortality, which is estimated at 8-25% without treatment. Symptoms include fever, tachycardia, heart failure, neurological changes, and gastrointestinal issues. Diagnosis is clinical based on symptoms and elevated thyroid hormone levels
Thyroid storm and myxedema coma are life-threatening emergencies caused by excess or deficiency of thyroid hormones respectively. Thyroid storm results from excessive thyroid hormones and causes hypermetabolism affecting multiple systems. Myxedema coma occurs in severe long-standing hypothyroidism when precipitated by an event and causes physiological decompensation. Both require rapid diagnosis and aggressive treatment in an ICU setting to prevent high mortality rates. Treatment involves supportive care, thyroid hormone replacement, glucocorticoids, and correcting underlying conditions.
Tumor lysis syndrome describes the clinical and laboratory abnormalities that result from the rapid release of intracellular contents from dying tumor cells. It is a common oncologic emergency seen by nephrologists. The rapid release of ions and metabolites causes hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Prevention focuses on identifying at-risk patients and aggressive hydration and urate-lowering agents. Treatment involves fluid management, management of electrolyte abnormalities with agents like rasburicase, and potentially renal replacement therapy for severe cases.
Hyperthyroidism is commonly caused by Graves' disease, which is an autoimmune disorder. Graves' disease accounts for 60-80% of hyperthyroidism cases. It is caused by antibodies that stimulate the thyroid gland and cause excessive production of thyroid hormones. Common symptoms include weight loss, rapid heartbeat, nervousness, and eye changes. The eyes may become protruded (proptosis), inflamed, and cause double vision (diplopia). Laboratory tests show suppressed TSH and elevated thyroid hormone levels. Graves' disease is treated by controlling thyroid hormone levels, managing eye symptoms, and in severe cases using medications, radiation therapy, or surgery.
This document provides an overview of neuroblastoma, including:
- It is the most common extracranial solid tumor in children, arising from neural crest cells in the sympathetic nervous system.
- Presentation varies depending on location but may include abdominal mass, bone pain, opsoclonus, or Horner's syndrome.
- Staging uses the International Neuroblastoma Staging System and ranges from localized (Stage 1) to disseminated disease (Stage 4).
- Treatment involves surgery, chemotherapy, and sometimes radiation therapy. Prognostic factors include age at diagnosis and disease stage.
1. Hyponatremia is defined as a serum sodium level below 135 mEq/L and can be classified as mild, moderate, or severe based on the serum sodium concentration.
2. Signs and symptoms range from nausea and malaise in mild cases to seizures and coma in severe cases and depend on the severity and chronicity of hyponatremia.
3. Causes of hyponatremia include excessive water intake, syndrome of inappropriate antidiuretic hormone secretion, and conditions affecting sodium balance such as liver disease, heart failure, and use of certain medications.
This document discusses childhood hypertension. Some key points:
- The prevalence of childhood hypertension and prehypertension has increased significantly since 2004. Around 3.5% of children have hypertension and 10-11% have prehypertension.
- Updated definitions were provided for normal, elevated, stage 1, and stage 2 blood pressure in children aged 1-13 years and over 13 years.
- Common causes of secondary hypertension in children include renal, vascular, and endocrine conditions. Evaluation involves taking a thorough history and physical exam and screening tests.
- Treatment involves identifying and managing underlying causes, lifestyle modifications, and medications if needed to control blood pressure. Regular monitoring is important.
Please find the power point on Management of antipsychotic overdose. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Thyroid storm and myxedema coma are life-threatening emergencies caused by excess or deficiency of thyroid hormones respectively. Thyroid storm results from excessive thyroid hormones and causes hypermetabolism affecting multiple systems. Myxedema coma occurs in severe long-standing hypothyroidism when precipitated by an event and causes physiological decompensation. Both require rapid diagnosis and aggressive treatment in an ICU setting to prevent high mortality rates. Treatment involves supportive care, thyroid hormone replacement, glucocorticoids, and correcting underlying conditions.
Tumor lysis syndrome describes the clinical and laboratory abnormalities that result from the rapid release of intracellular contents from dying tumor cells. It is a common oncologic emergency seen by nephrologists. The rapid release of ions and metabolites causes hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Prevention focuses on identifying at-risk patients and aggressive hydration and urate-lowering agents. Treatment involves fluid management, management of electrolyte abnormalities with agents like rasburicase, and potentially renal replacement therapy for severe cases.
Hyperthyroidism is commonly caused by Graves' disease, which is an autoimmune disorder. Graves' disease accounts for 60-80% of hyperthyroidism cases. It is caused by antibodies that stimulate the thyroid gland and cause excessive production of thyroid hormones. Common symptoms include weight loss, rapid heartbeat, nervousness, and eye changes. The eyes may become protruded (proptosis), inflamed, and cause double vision (diplopia). Laboratory tests show suppressed TSH and elevated thyroid hormone levels. Graves' disease is treated by controlling thyroid hormone levels, managing eye symptoms, and in severe cases using medications, radiation therapy, or surgery.
This document provides an overview of neuroblastoma, including:
- It is the most common extracranial solid tumor in children, arising from neural crest cells in the sympathetic nervous system.
- Presentation varies depending on location but may include abdominal mass, bone pain, opsoclonus, or Horner's syndrome.
- Staging uses the International Neuroblastoma Staging System and ranges from localized (Stage 1) to disseminated disease (Stage 4).
- Treatment involves surgery, chemotherapy, and sometimes radiation therapy. Prognostic factors include age at diagnosis and disease stage.
1. Hyponatremia is defined as a serum sodium level below 135 mEq/L and can be classified as mild, moderate, or severe based on the serum sodium concentration.
2. Signs and symptoms range from nausea and malaise in mild cases to seizures and coma in severe cases and depend on the severity and chronicity of hyponatremia.
3. Causes of hyponatremia include excessive water intake, syndrome of inappropriate antidiuretic hormone secretion, and conditions affecting sodium balance such as liver disease, heart failure, and use of certain medications.
This document discusses childhood hypertension. Some key points:
- The prevalence of childhood hypertension and prehypertension has increased significantly since 2004. Around 3.5% of children have hypertension and 10-11% have prehypertension.
- Updated definitions were provided for normal, elevated, stage 1, and stage 2 blood pressure in children aged 1-13 years and over 13 years.
- Common causes of secondary hypertension in children include renal, vascular, and endocrine conditions. Evaluation involves taking a thorough history and physical exam and screening tests.
- Treatment involves identifying and managing underlying causes, lifestyle modifications, and medications if needed to control blood pressure. Regular monitoring is important.
Please find the power point on Management of antipsychotic overdose. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Leukemias are the most common cancers in children, with acute lymphoblastic leukemia (ALL) accounting for 73% of cases and acute myeloid leukemia (AML) accounting for 18% of cases. ALL peaks between ages 2-5 years and accounts for 25-30% of all childhood cancers. Treatment involves induction, consolidation/intensification, and continuation phases using chemotherapy protocols over 2-3 years. Supportive care and risk stratification are important for managing treatment and prognosis.
Neuroblastoma is the most common cancer in babies and the third-most common cancer in children after leukemia and brain cancer, proper diagnosis, treatment must be done in appropriate time. As it a fatal condition psychosocial support is most important for patient and family.
A 76-year-old male is admitted to the ICU for recovery after lung surgery. His BP is 168/96 mmHg without end-organ damage, so this represents a hypertensive urgency rather than emergency. Fundoscopic exam is not needed for this transient postoperative hypertension. Starting IV antihypertensives or consulting a hypertension specialist are not necessary actions at this time. The patient should be reassessed later since there is no end-organ damage currently.
Status epilepticus (SE) is a medical emergency defined by continuous seizure activity lasting more than 5 minutes for generalized seizures or more than 10 minutes for focal seizures. The condition requires rapid treatment to prevent neuronal injury and death from prolonged excitatory activity. Management involves initial airway and hemodynamic stabilization, followed by benzodiazepines as first-line treatment. If seizures continue, second-line drugs like phenytoin are used. Refractory SE fails to respond to first- and second-line drugs, while super-refractory SE continues despite anesthesia with midazolam or barbiturates. Early, aggressive treatment is needed to terminate seizures and prevent neurological complications.
1. Lymphoma is the third most common childhood cancer and is broadly categorized into Hodgkin's disease and non-Hodgkin's lymphoma.
2. Hodgkin's disease is characterized by Reed-Sternberg cells and is further classified under Rye or REAL systems. Common subtypes include lymphocyte predominant, mixed cellularity, and nodular sclerosis.
3. Non-Hodgkin's lymphoma in children includes subtypes like Burkitt's lymphoma, lymphoblastic lymphoma, diffuse large B-cell lymphoma, and anaplastic large cell lymphoma.
This document discusses hypothyroidism, including three patient cases. It covers the epidemiology, causes, clinical presentation, diagnosis, and treatment of hypothyroidism. The key points are:
1) Hypothyroidism can be primary (thyroid gland failure) or secondary (insufficient TSH stimulation). The most common cause is autoimmune thyroid disease. Clinical symptoms vary but include fatigue, weight gain, and depression.
2) Diagnosis is made through lab tests - an elevated TSH with low free T4 indicates primary hypothyroidism. Subclinical hypothyroidism has an elevated TSH but normal free T4.
3) Treatment is lifelong levothyroxine
This document discusses hypertension in pediatrics. It defines different types and stages of hypertension based on blood pressure percentiles. Secondary hypertension is most common in infants and children and is usually caused by an underlying condition. Accurate blood pressure measurements should be taken routinely starting at age 3. Treatment involves identifying and managing the underlying cause, lifestyle changes like salt restriction, and medications like ACE inhibitors, ARBs, calcium channel blockers, and diuretics. Hypertensive emergencies require promptly but gradually lowering blood pressure over hours to days to prevent end organ damage, while hypertensive urgencies can be treated orally by lowering blood pressure over 1-2 days.
This document discusses tumor lysis syndrome (TLS), which can occur when tumors undergo rapid cell lysis and release intracellular contents into the bloodstream. TLS can cause electrolyte abnormalities and renal failure. It affects patients with highly proliferative tumors undergoing chemotherapy, radiation or other treatments. The document outlines risk factors, grading criteria, clinical manifestations, prevention strategies including hydration, uric acid reduction and dialysis, as well as treatment of established TLS complications. It also covers hyperleukocytosis, a related condition seen in some leukemia patients.
Common drug induced liver injury in children -dr. harshad devarbhaiSanjeev Kumar
This document discusses common drug-induced liver injury in children. It presents two case studies of pediatric patients who developed acute liver failure after receiving multiple drug treatments. Liver enzyme levels increased dramatically in both patients, and one child died of hyperacute liver failure while the other died shortly after admission. The document reviews the challenges of pediatric drug-induced liver injury given differences in drug metabolism and formulations in children. Common culprit drugs identified are antituberculosis medications, acetaminophen, and anti-epileptic drugs. Younger age is a risk factor for valproate hepatotoxicity. Prompt identification and discontinuation of the offending drug is important to prevent serious outcomes like acute liver failure.
This document discusses potassium metabolism and the approach to hyperkalemia. It begins with an introduction to potassium physiology and homeostasis. The kidney plays a key role in potassium excretion, reabsorbing 85-90% in the distal tubules where regulation occurs. Hyperkalemia is defined as a serum potassium over 5.5 mEq/L and can be caused by increased potassium load, impaired excretion, or transcellular shifting. Treatment focuses on stabilizing cardiac cells, rapidly lowering potassium levels, and enhancing elimination while addressing the underlying cause. Emergency therapies include calcium gluconate, insulin therapy, beta agonists, and sodium polystyrene sulfonate.
Case presentation of primary hyperparathyroidismHaifa Alshwikh
This case presentation describes a 44-year-old woman who presented with left hip pain and was found to have hypercalcemia. The differential diagnosis for her hypercalcemia includes primary hyperparathyroidism, familial hypocalciuric hyperparathyroidism, and tertiary hyperparathyroidism. She underwent laboratory testing which showed elevated PTH, consistent with primary hyperparathyroidism. Localization testing with sestamibi scan and ultrasound were recommended to help guide minimally invasive parathyroidectomy.
This document discusses thyroid disorders in children. It covers transient neonatal hypothyroidism, congenital hypothyroidism, acquired hypothyroidism (including Hashimoto's thyroiditis), hyperthyroidism (including Graves' disease), and their treatment. The key signs and symptoms, investigations, and treatment approaches are outlined for each condition. Treatment typically involves levothyroxine replacement and monitoring of thyroid function tests. Anti-thyroid medications are also used to treat hyperthyroidism.
1. Nephroblastoma, also known as Wilms tumor, is the most common renal malignancy in children. It typically presents as an abdominal mass and can metastasize to lungs, liver, and bone.
2. Treatment involves nephrectomy followed by chemotherapy based on stage and histology. Radiation therapy may be given for local control in certain high risk cases.
3. With multimodal therapy, the cure rate for Wilms tumor is now over 90%. Ongoing surveillance is important due to risk of recurrence or secondary tumors.
This document discusses oncological emergencies, including tumor lysis syndrome, malignant hypercalcemia, superior vena cava syndrome, and others. It provides details on the definitions, causes, clinical presentations, diagnostic criteria, and treatment approaches for these time-sensitive cancer complications. Tumor lysis syndrome can result from cell lysis releasing uric acid and electrolytes, and requires aggressive hydration, allopurinol or rasburicase, and renal replacement therapy if severe. Malignant hypercalcemia is most common in breast and lung cancers and multiple myeloma, presenting with nausea, fatigue, and neurological symptoms, treated initially with hydration and bisphosphonates. Superior vena cava syndrome ob
This document provides information on paediatric oncology and various childhood cancers. It discusses that benign tumors are more common than malignant tumors in children, but cancer is a leading cause of death after accidents. The most common malignant tumors in children arise from hematopoietic, nervous and soft tissues. It then describes several specific childhood cancers like acute lymphoblastic leukemia, Wilms tumor, neuroblastoma, Hodgkin's lymphoma, and non-Hodgkin lymphoma. For each cancer, it discusses clinical features, diagnostic evaluation, classification, treatment and prognosis.
This document discusses hyperthyroidism and thyrotoxicosis. It begins by defining the terms and describing the thyroid gland's normal function. It then discusses the various causes of hyperthyroidism including Graves' disease, toxic multinodular goiter, subacute thyroiditis, and toxic adenoma. The document outlines the anatomy and physiology of the thyroid gland. It describes the clinical manifestations, diagnostic tests including thyroid function tests, ultrasound, and thyroid scintigraphy. It provides algorithms for diagnosis and outlines treatment options for hyperthyroidism including anti-thyroid medications, radioactive iodine treatment, and thyroidectomy.
This document provides information on febrile neutropenia, including:
- It is a common and serious complication of cancer chemotherapy, especially in those with hematologic malignancies.
- Initial evaluation of febrile neutropenic patients includes assessing infection risk factors and sites, as well as collecting blood and other cultures.
- High-risk patients require intravenous empirical antibiotic therapy in the hospital, while low-risk patients may be treated orally or as outpatients.
- Empirical therapy typically involves a broad-spectrum beta-lactam with coverage against pseudomonas, with vancomycin or other anti-gram positive coverage only added if clinically indicated. Therapy is continued until marrow recovery from neutropenia
The document provides guidelines for evaluating and managing hypertension in children and adolescents, including recommended methods for blood pressure measurement, definitions of normal and elevated blood pressure levels, potential causes of primary and secondary hypertension at different ages, screening tests and workup for underlying conditions, and monitoring of patients. Evaluation involves assessing family history, performing a physical exam, and obtaining lab tests and imaging studies to identify secondary causes and end-organ damage from high blood pressure.
Acute liver failure is characterized by acute liver injury, hepatic encephalopathy, and elevated INR within 26 weeks without previous liver disease. Common causes include acetaminophen toxicity, viral infections, and idiosyncratic drug reactions. Patients present with symptoms like fatigue, nausea, and jaundice. Complications include cerebral edema, renal failure, electrolyte imbalances, coagulopathy, and infections. Treatment focuses on supportive care, treating encephalopathy, and consideration of liver transplantation for eligible patients. Prognosis depends on the degree of encephalopathy and presence of other risk factors.
This document discusses the management of thyroid storm, a life-threatening condition characterized by a hypermetabolic state caused by underlying hyperthyroidism. Key points include:
- Thyroid storm is diagnosed clinically or using scoring tools like the Burch-Wartofsky Point Scale.
- Management aims to inhibit thyroid hormone synthesis/release and peripheral effects while reversing decompensation. This involves high-dose antithyroid drugs, beta blockers, corticosteroids, inorganic iodide, and treating any precipitating factors.
- Supportive treatments like IV fluids and nutrition are also important, along with considering urgent thyroidectomy or radioactive iodine in some cases. Patient education is crucial
Hyperthyroidism and thyrotoxicosis occur when the thyroid gland overproduces thyroid hormones. Thyroid storm is a life-threatening exacerbation of thyrotoxicosis caused by factors like infection, surgery, or medication changes. It involves fever, sweating, tachycardia, anxiety, and heart failure. Treatment focuses on cooling the patient, blocking further hormone production with antithyroid drugs and iodine, and supporting heart and brain function with beta-blockers and glucocorticoids. Thyroidectomy may be required for severe cases not responding to medical management.
Thyroid storm is a life-threatening exacerbation of hyperthyroidism that can be fatal if not treated promptly and aggressively. It is usually precipitated by stress in individuals with poorly controlled hyperthyroidism. Signs and symptoms involve multiple organ systems and include fever, tachycardia, heart failure, gastrointestinal issues, and altered mental status. Treatment requires addressing the underlying hyperthyroidism with antithyroid drugs, iodine, beta-blockers, and glucocorticoids to suppress hormone production and effects. Managing precipitating factors, supportive care, and monitoring for complications are also important.
Leukemias are the most common cancers in children, with acute lymphoblastic leukemia (ALL) accounting for 73% of cases and acute myeloid leukemia (AML) accounting for 18% of cases. ALL peaks between ages 2-5 years and accounts for 25-30% of all childhood cancers. Treatment involves induction, consolidation/intensification, and continuation phases using chemotherapy protocols over 2-3 years. Supportive care and risk stratification are important for managing treatment and prognosis.
Neuroblastoma is the most common cancer in babies and the third-most common cancer in children after leukemia and brain cancer, proper diagnosis, treatment must be done in appropriate time. As it a fatal condition psychosocial support is most important for patient and family.
A 76-year-old male is admitted to the ICU for recovery after lung surgery. His BP is 168/96 mmHg without end-organ damage, so this represents a hypertensive urgency rather than emergency. Fundoscopic exam is not needed for this transient postoperative hypertension. Starting IV antihypertensives or consulting a hypertension specialist are not necessary actions at this time. The patient should be reassessed later since there is no end-organ damage currently.
Status epilepticus (SE) is a medical emergency defined by continuous seizure activity lasting more than 5 minutes for generalized seizures or more than 10 minutes for focal seizures. The condition requires rapid treatment to prevent neuronal injury and death from prolonged excitatory activity. Management involves initial airway and hemodynamic stabilization, followed by benzodiazepines as first-line treatment. If seizures continue, second-line drugs like phenytoin are used. Refractory SE fails to respond to first- and second-line drugs, while super-refractory SE continues despite anesthesia with midazolam or barbiturates. Early, aggressive treatment is needed to terminate seizures and prevent neurological complications.
1. Lymphoma is the third most common childhood cancer and is broadly categorized into Hodgkin's disease and non-Hodgkin's lymphoma.
2. Hodgkin's disease is characterized by Reed-Sternberg cells and is further classified under Rye or REAL systems. Common subtypes include lymphocyte predominant, mixed cellularity, and nodular sclerosis.
3. Non-Hodgkin's lymphoma in children includes subtypes like Burkitt's lymphoma, lymphoblastic lymphoma, diffuse large B-cell lymphoma, and anaplastic large cell lymphoma.
This document discusses hypothyroidism, including three patient cases. It covers the epidemiology, causes, clinical presentation, diagnosis, and treatment of hypothyroidism. The key points are:
1) Hypothyroidism can be primary (thyroid gland failure) or secondary (insufficient TSH stimulation). The most common cause is autoimmune thyroid disease. Clinical symptoms vary but include fatigue, weight gain, and depression.
2) Diagnosis is made through lab tests - an elevated TSH with low free T4 indicates primary hypothyroidism. Subclinical hypothyroidism has an elevated TSH but normal free T4.
3) Treatment is lifelong levothyroxine
This document discusses hypertension in pediatrics. It defines different types and stages of hypertension based on blood pressure percentiles. Secondary hypertension is most common in infants and children and is usually caused by an underlying condition. Accurate blood pressure measurements should be taken routinely starting at age 3. Treatment involves identifying and managing the underlying cause, lifestyle changes like salt restriction, and medications like ACE inhibitors, ARBs, calcium channel blockers, and diuretics. Hypertensive emergencies require promptly but gradually lowering blood pressure over hours to days to prevent end organ damage, while hypertensive urgencies can be treated orally by lowering blood pressure over 1-2 days.
This document discusses tumor lysis syndrome (TLS), which can occur when tumors undergo rapid cell lysis and release intracellular contents into the bloodstream. TLS can cause electrolyte abnormalities and renal failure. It affects patients with highly proliferative tumors undergoing chemotherapy, radiation or other treatments. The document outlines risk factors, grading criteria, clinical manifestations, prevention strategies including hydration, uric acid reduction and dialysis, as well as treatment of established TLS complications. It also covers hyperleukocytosis, a related condition seen in some leukemia patients.
Common drug induced liver injury in children -dr. harshad devarbhaiSanjeev Kumar
This document discusses common drug-induced liver injury in children. It presents two case studies of pediatric patients who developed acute liver failure after receiving multiple drug treatments. Liver enzyme levels increased dramatically in both patients, and one child died of hyperacute liver failure while the other died shortly after admission. The document reviews the challenges of pediatric drug-induced liver injury given differences in drug metabolism and formulations in children. Common culprit drugs identified are antituberculosis medications, acetaminophen, and anti-epileptic drugs. Younger age is a risk factor for valproate hepatotoxicity. Prompt identification and discontinuation of the offending drug is important to prevent serious outcomes like acute liver failure.
This document discusses potassium metabolism and the approach to hyperkalemia. It begins with an introduction to potassium physiology and homeostasis. The kidney plays a key role in potassium excretion, reabsorbing 85-90% in the distal tubules where regulation occurs. Hyperkalemia is defined as a serum potassium over 5.5 mEq/L and can be caused by increased potassium load, impaired excretion, or transcellular shifting. Treatment focuses on stabilizing cardiac cells, rapidly lowering potassium levels, and enhancing elimination while addressing the underlying cause. Emergency therapies include calcium gluconate, insulin therapy, beta agonists, and sodium polystyrene sulfonate.
Case presentation of primary hyperparathyroidismHaifa Alshwikh
This case presentation describes a 44-year-old woman who presented with left hip pain and was found to have hypercalcemia. The differential diagnosis for her hypercalcemia includes primary hyperparathyroidism, familial hypocalciuric hyperparathyroidism, and tertiary hyperparathyroidism. She underwent laboratory testing which showed elevated PTH, consistent with primary hyperparathyroidism. Localization testing with sestamibi scan and ultrasound were recommended to help guide minimally invasive parathyroidectomy.
This document discusses thyroid disorders in children. It covers transient neonatal hypothyroidism, congenital hypothyroidism, acquired hypothyroidism (including Hashimoto's thyroiditis), hyperthyroidism (including Graves' disease), and their treatment. The key signs and symptoms, investigations, and treatment approaches are outlined for each condition. Treatment typically involves levothyroxine replacement and monitoring of thyroid function tests. Anti-thyroid medications are also used to treat hyperthyroidism.
1. Nephroblastoma, also known as Wilms tumor, is the most common renal malignancy in children. It typically presents as an abdominal mass and can metastasize to lungs, liver, and bone.
2. Treatment involves nephrectomy followed by chemotherapy based on stage and histology. Radiation therapy may be given for local control in certain high risk cases.
3. With multimodal therapy, the cure rate for Wilms tumor is now over 90%. Ongoing surveillance is important due to risk of recurrence or secondary tumors.
This document discusses oncological emergencies, including tumor lysis syndrome, malignant hypercalcemia, superior vena cava syndrome, and others. It provides details on the definitions, causes, clinical presentations, diagnostic criteria, and treatment approaches for these time-sensitive cancer complications. Tumor lysis syndrome can result from cell lysis releasing uric acid and electrolytes, and requires aggressive hydration, allopurinol or rasburicase, and renal replacement therapy if severe. Malignant hypercalcemia is most common in breast and lung cancers and multiple myeloma, presenting with nausea, fatigue, and neurological symptoms, treated initially with hydration and bisphosphonates. Superior vena cava syndrome ob
This document provides information on paediatric oncology and various childhood cancers. It discusses that benign tumors are more common than malignant tumors in children, but cancer is a leading cause of death after accidents. The most common malignant tumors in children arise from hematopoietic, nervous and soft tissues. It then describes several specific childhood cancers like acute lymphoblastic leukemia, Wilms tumor, neuroblastoma, Hodgkin's lymphoma, and non-Hodgkin lymphoma. For each cancer, it discusses clinical features, diagnostic evaluation, classification, treatment and prognosis.
This document discusses hyperthyroidism and thyrotoxicosis. It begins by defining the terms and describing the thyroid gland's normal function. It then discusses the various causes of hyperthyroidism including Graves' disease, toxic multinodular goiter, subacute thyroiditis, and toxic adenoma. The document outlines the anatomy and physiology of the thyroid gland. It describes the clinical manifestations, diagnostic tests including thyroid function tests, ultrasound, and thyroid scintigraphy. It provides algorithms for diagnosis and outlines treatment options for hyperthyroidism including anti-thyroid medications, radioactive iodine treatment, and thyroidectomy.
This document provides information on febrile neutropenia, including:
- It is a common and serious complication of cancer chemotherapy, especially in those with hematologic malignancies.
- Initial evaluation of febrile neutropenic patients includes assessing infection risk factors and sites, as well as collecting blood and other cultures.
- High-risk patients require intravenous empirical antibiotic therapy in the hospital, while low-risk patients may be treated orally or as outpatients.
- Empirical therapy typically involves a broad-spectrum beta-lactam with coverage against pseudomonas, with vancomycin or other anti-gram positive coverage only added if clinically indicated. Therapy is continued until marrow recovery from neutropenia
The document provides guidelines for evaluating and managing hypertension in children and adolescents, including recommended methods for blood pressure measurement, definitions of normal and elevated blood pressure levels, potential causes of primary and secondary hypertension at different ages, screening tests and workup for underlying conditions, and monitoring of patients. Evaluation involves assessing family history, performing a physical exam, and obtaining lab tests and imaging studies to identify secondary causes and end-organ damage from high blood pressure.
Acute liver failure is characterized by acute liver injury, hepatic encephalopathy, and elevated INR within 26 weeks without previous liver disease. Common causes include acetaminophen toxicity, viral infections, and idiosyncratic drug reactions. Patients present with symptoms like fatigue, nausea, and jaundice. Complications include cerebral edema, renal failure, electrolyte imbalances, coagulopathy, and infections. Treatment focuses on supportive care, treating encephalopathy, and consideration of liver transplantation for eligible patients. Prognosis depends on the degree of encephalopathy and presence of other risk factors.
This document discusses the management of thyroid storm, a life-threatening condition characterized by a hypermetabolic state caused by underlying hyperthyroidism. Key points include:
- Thyroid storm is diagnosed clinically or using scoring tools like the Burch-Wartofsky Point Scale.
- Management aims to inhibit thyroid hormone synthesis/release and peripheral effects while reversing decompensation. This involves high-dose antithyroid drugs, beta blockers, corticosteroids, inorganic iodide, and treating any precipitating factors.
- Supportive treatments like IV fluids and nutrition are also important, along with considering urgent thyroidectomy or radioactive iodine in some cases. Patient education is crucial
Hyperthyroidism and thyrotoxicosis occur when the thyroid gland overproduces thyroid hormones. Thyroid storm is a life-threatening exacerbation of thyrotoxicosis caused by factors like infection, surgery, or medication changes. It involves fever, sweating, tachycardia, anxiety, and heart failure. Treatment focuses on cooling the patient, blocking further hormone production with antithyroid drugs and iodine, and supporting heart and brain function with beta-blockers and glucocorticoids. Thyroidectomy may be required for severe cases not responding to medical management.
Thyroid storm is a life-threatening exacerbation of hyperthyroidism that can be fatal if not treated promptly and aggressively. It is usually precipitated by stress in individuals with poorly controlled hyperthyroidism. Signs and symptoms involve multiple organ systems and include fever, tachycardia, heart failure, gastrointestinal issues, and altered mental status. Treatment requires addressing the underlying hyperthyroidism with antithyroid drugs, iodine, beta-blockers, and glucocorticoids to suppress hormone production and effects. Managing precipitating factors, supportive care, and monitoring for complications are also important.
This document summarizes information about hypothyroidism and hyperthyroidism (thyrotoxicosis). It discusses the epidemiology, causes, clinical manifestations, investigations, treatment, and prevention of hypothyroidism. For hyperthyroidism/thyrotoxicosis, it covers the epidemiology, causes, clinical signs and symptoms, investigations, treatment options including anti-thyroid drugs, surgery and radioactive iodine, and considerations for treatment in pregnancy. It also provides details on myxedema coma, a rare but serious complication of severe untreated hypothyroidism.
Thyroid storm is a life-threatening complication of hyperthyroidism where the symptoms of thyrotoxicosis are exaggerated. It is precipitated by an acute stressor in a patient with hyperthyroidism. Diagnosis is clinical based on fever, tachycardia, heart failure, psychiatric symptoms, and gastrointestinal issues. Treatment involves controlling adrenergic tone with beta-blockers, reducing thyroid hormone synthesis with antithyroid drugs, and supportive care. The Burch-Wartofsky Point Scale and Japanese Thyroid Association criteria can help diagnose thyroid storm. Early diagnosis and aggressive management are needed to reduce the 8-25% mortality risk associated with this condition.
This document discusses thyroid and parathyroid disorders and their anesthetic considerations. It covers:
1. The anatomy, physiology, and normal lab values related to thyroid function. Hypothyroidism and hyperthyroidism can increase or decrease various thyroid hormone levels.
2. The causes, signs and symptoms, diagnosis, and treatment of hyperthyroidism/thyrotoxicosis and thyroid storm. Thyroid storm is a life-threatening exacerbation of thyrotoxicosis that requires immediate intensive care.
3. The causes, pathophysiology, diagnosis, and treatment of hypothyroidism and myxedema coma. Myxedema coma is a severe form of decompensated
This document summarizes thyroid storm, an extreme manifestation of hyperthyroidism. It describes the etiology as usually involving a precipitating factor in addition to hyperthyroidism. Signs and symptoms are severe and can involve multiple organ systems. Management requires promptly blocking thyroid hormone synthesis and secretion, blocking peripheral thyroid hormone action, and providing supportive care measures to stabilize the patient's homeostasis and address underlying causes.
hyperthyroidism, thyrotoxicosis, grave disease, thyroid storm, pregnancy, high risk pregnancy, pregnancy complications, management of thyrotoxicosis and thyroid storm in pregnancy
Graves' disease is an autoimmune disorder causing hyperthyroidism in 60-80% of cases. Genetic and environmental factors contribute to susceptibility. Smoking increases the risk of ophthalmopathy. Hyperthyroidism is caused by thyroid stimulating immunoglobulins that activate the TSH receptor and cause overproduction of thyroid hormones. Treatment involves antithyroid drugs, radioiodine ablation, or surgery. Ophthalmopathy may cause eye swelling, bulging, and vision issues. Thyroiditis refers to inflammation of the thyroid and can be acute, subacute, or chronic depending on duration and symptoms. Subacute thyroiditis causes thyroid pain and temporary changes in thyroid function. Pregnancy causes changes in
This document summarizes information about hyperthyroidism and hypothyroidism, including their common causes, symptoms, signs, investigations, and treatment approaches. The most common causes are Graves' disease, multinodular goiter, and solitary thyroid adenomas. Common symptoms include weight loss, heat intolerance, palpitations, and tremors. Diagnostic testing involves measuring T3, T4, and TSH levels. Treatment depends on the underlying cause, and may include antithyroid drugs, radioactive iodine, surgery, or beta-blockers to control symptoms.
A 27-year-old female presents with palpitations. Exam finds an enlarged, tender thyroid. Labs show suppressed TSH, elevated T4 and low radioactive iodine uptake. The next appropriate test would be to check the ESR, as these findings are consistent with subacute thyroiditis, an inflammation of the thyroid gland often caused by a viral infection. The treatment is symptomatic with pain medication; the condition will typically resolve on its own over several months.
A 27-year-old female presents with palpitations. Exam finds an enlarged, tender thyroid. Labs show suppressed TSH, elevated T4 and low radioactive iodine uptake. The next appropriate test would be to check the ESR, as these findings are consistent with subacute thyroiditis, an inflammation of the thyroid gland often caused by a viral infection. The treatment is symptomatic with pain medication as the condition will typically resolve on its own over several months.
This document discusses endocrine diseases and their implications for anesthesia. It covers both hyperthyroidism and hypothyroidism in detail. For hyperthyroidism, it describes the signs and symptoms, causes, effects on the cardiovascular system, and treatment approaches including antithyroid medications, beta blockers, iodine, and surgery. It provides guidance on preoperative preparation and intraoperative management. For hypothyroidism, it discusses signs and symptoms, effects on the cardiovascular system, diagnosis, and treatment with levothyroxine. It notes risks for anesthesia and importance of rendering patients euthyroid prior to elective surgery.
This document discusses thyrotoxicosis, which results from excess thyroid hormone production regardless of cause. It is one of the more common endocrine disorders seen by family physicians. The causes of thyrotoxicosis include Graves' disease, toxic multinodular goiter, solitary toxic nodule, and thyroiditis. Graves' disease is an autoimmune condition characterized by a diffuse goiter, ophthalmopathy, and dermopathy. Toxic multinodular goiter develops from autonomy in a pre-existing nodular goiter. A solitary toxic nodule refers to autonomy developing in an otherwise normal thyroid. Thyroiditis can cause a transient thyrotoxic phase followed by hypothyroidism. Treatment depends on
Thyroid storm, also known as thyrotoxic crisis, is a life-threatening complication of hyperthyroidism characterized by sudden multisystem involvement. It can occur in any diagnosed or undiagnosed case of hyperthyroidism. Thyroid storm is diagnosed clinically based on symptoms involving the central nervous, cardiovascular, gastrointestinal and hepatic systems. Treatment involves controlling adrenergic tone with beta-blockers, reducing thyroid hormone synthesis with thionamides, and blocking peripheral thyroid hormone conversion. Aggressive treatment is required for patients scoring above 45 on the Burch-Wartofsky Point Scale or meeting the criteria for definite or suspected thyroid storm per the Japanese Thyroid Association guidelines.
Thyroid storm is a life-threatening syndrome that results from an acute exacerbation of thyrotoxicosis. Prevention, prompt recognition, and appropriate intervention as discussed herein are key to the prevention of death and morbidity in affected patients. I hope you find it educating as well as enlightening.
A 58-year-old woman presents with symptoms of hyperthyroidism including anxiety, tremors, sweating, palpitations and insomnia. On exam she has a modest, non-tender goiter. Thyroid function tests show a suppressed TSH and elevated free T4, consistent with primary hyperthyroidism. A thyroid uptake scan shows diffuse homogeneous uptake, consistent with Graves' disease. She is started on methimizole to treat her hyperthyroidism due to Graves' disease.
Hypothyroidism Diagnosis, Etiopathogenesis and TreatmentPranatiChavan
Hypothyroidism is a condition in which the thyroid gland doesn't produce enough thyroid hormone.
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This document summarizes management of hyperthyroidism. It discusses the epidemiology, causes, symptoms, complications, and treatment options for hyperthyroidism including radioactive iodine, surgery, antithyroid medications, and their adverse effects. It also reviews guidelines for diagnosing and treating thyroid disorders during pregnancy, the prevalence of thyroid cancer in hyperthyroidism patients, and literature on managing hyperthyroidism in Asia and Saudi Arabia.
The document discusses various thyroid disorders including hyperthyroidism, hypothyroidism, thyroiditis, thyroid nodules, thyroid cancer, and parathyroid glands. It covers the causes, signs and symptoms, diagnostic tests, and treatment options for different thyroid conditions. Lab tests like TSH, T4, and radioactive iodine uptake can help evaluate thyroid function and differentiate disorders. Diseases discussed include Graves' disease, Hashimoto's thyroiditis, toxic nodular goiter, hypothyroidism, thyroiditis, and thyroid cancer.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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3. Introduction
Thyroid storm, also known as thyrotoxic crisis, is an acute, life-threatening complication of hyperthyroidism.
It is an exaggerated presentation of thyrotoxicosis. It comes with sudden multisystem involvement. The
mortality associated with thyroid storm is estimated to be 8-25% despite modern advancements in its
treatment and supportive measures. [1] Thus, it is very important to recognize it early and start aggressive
treatment to reduce mortality. The diagnosis of thyroid storm is clinical.
4. Etiology
Superimposed precipitating factors cause thyroid storm in patients with diagnosed or undiagnosed
hyperthyroidism. It is more common with Graves’ disease but can occur with other etiologies of
hyperthyroidism, for example, toxic multinodular goiter and toxic adenoma of the thyroid.[2] The
precipitating factors are: Abrupt discontinuation of antithyroid medicine Thyroid surgery Non-
thyroid surgery Trauma Acute illness like infections, diabetic ketoacidosis, acute myocardial
infarction, cardiovascular accident, cardiac failure, drug reaction Parturition Recent use of Iodinated
contrast medium Radioiodine therapy (rare) Burns Stroke Medication side effect e.g. amiodarone,
anesthetics, salicylates.
5. Epidemiology
It is a rare presentation of hyperthyroidism. Thyroid storm accounts for about 1% to 2% of admissions
for hyperthyroidism. As per the United States survey, the incidence of storm ranged from 0.57 t0 0.76
cases per 100,000 per year in the normal population, and 4.8 to 5.6 cases/100,000 per year in
hospitalized patients.[3] As per the Japanese National Survey, the incidence of thyroid storm was 0.2
per 100,000 population per year, about 0.22% of all thyrotoxicosis patients and 5.4% of hospitalized
thyrotoxicosis patients. The average age of people with thyroid storm was 42 to 43 years, which was
similar to people with thyrotoxicosis without thyroid storm. The male to female ratio for the incidence
of thyroid storm was about 1:3, similar to thyrotoxicosis without storm group.[4]
6. Pathophysiology
The pathophysiological basis for precipitation of thyroid storm in patients with
thyrotoxicosis is not clear. But, a precipitating factor, as mentioned above, is always
required to cause thyroid storm. Several hypotheses have been purposed. One
hypothesis suggests the incidence of thyroid storm is due to the rapid increase in
thyroid hormone levels, rather than the absolute hormone level that occurs during
thyroid surgery, following radioactive iodine treatment, after sudden
discontinuation of the antithyroid drug, or after administration of the large dose of
iodine in contrast studies. The hyperactivity of the sympathetic nervous system with
increased response to catecholamine along with an increased cellular response to
thyroid hormone during acute stress or infections, causing cytokines release and
altered immunological disturbances, are other possible mechanisms of thyroid
storm. Most studies have failed to relate higher thyroid hormone levels as a cause
of thyroid storm, except for the study by Brooks and others, reported higher free
thyroid hormone among the patients with thyroid storm.[5] In other words, the
degree of thyroid hormone level is not directly related to a higher incidence of
thyroid storm.[2] The clinical features are due to the exaggerated effects of the
thyroid hormone. There is intense metabolic activity which increases oxygen
requirements. The resulting tachycardia to meet the oxygen requirements can
induce heart failure and predisposes the patient to arrhythmias. Similarly, the CNS
symptoms include irritability, seizures, delirium, and eventually coma.
7. Histopathology
Histopathology depends on the cause of the thyroid storm. The most
common cause Grave's disease shows diffuse follicular hyperplasia
along with increased thyroid receptor antibodies and increased
vascularization to the tissue. If it is a tumor causing storm, malignant
cells infiltrate and destroy the thyroid tissue freely, and rupture the
follicles
8.
9. History and Physical
Presentation of thyroid storm is an exaggerated manifestation of
hyperthyroidism, with the presence of an acute precipitating factor. Fever,
cardiovascular involvement (including tachycardia, heart failure, arrhythmia),
central nervous system (CNS) manifestations, and gastrointestinal symptoms are
common. Fever of 104 F to 106 F with diaphoresis is a key presenting feature.
Cardiovascular manifestations include tachycardia more than 140 HR/minute,
heart failure with pulmonary edema and peripheral edema, hypotension,
arrhythmia, and death from cardiac arrest. CNS involvement includes agitation,
delirium, anxiety, psychosis, or coma. Gastrointestinal (GI) symptoms include
nausea, vomiting, diarrhea, abdominal pain, intestinal obstruction, and acute
hepatic failure. A Japanese study found the CNS involvement to be a poor
prognostic factor for increased mortality.Physical examination findings may
include high temperature, tachycardia, orbitopathy, goiter, hand tremors, moist
and warm skin, hyperreflexia, systolic hypertension, and jaundice.
10. Evaluation
The diagnosis of thyroid storm needs clinical suspicion based on the
presentation mentioned above in a patient with hyperthyroidism or
suspected hyperthyroidism. One should not wait for lab results before
starting treatment. Thyroid function tests can be obtained which
usually show high FT4/FT3 and low TSH. It is not necessary to have a
very high level of thyroid hormone to cause thyroid storm. Other lab
abnormalities may include hypercalcemia, hyperglycemia (due to
inhibition of insulin release and increased glycogenolysis), abnormal
LFTs, high or low white blood cell (WBC) count.
11. Diagnosis
Definite Thyroid Storm (TS1): Thyrotoxicosis (elevated FT3 and/or FT4) plus At least
one CNS manifestation plus one or more other symptoms (fever, tachycardia, CHF,
GI/Hepatic) ‘OR’ A combination of at least three features among fever, GI/Hepatic, CHF,
or tachycardia Suspected Thyroid Storm (TS2): Thyrotoxicosis (elevated FT3 and/or
FT4) .
A combination of at least two features among tachycardia, CHF, GI/Hepatic, Fever ‘OR’
A patient with h/o thyroid disease, presence of goiter and exophthalmos who meets
criteria for TS1 but TFTs not available These scoring systems are just guidelines. The
actual diagnosis is based on clinical judgment. Based on the BWPS scoring system, a
score of 45 or more is more sensitive but less specific than JTA scoring systems TS1 or
TS2 to detect thyroid storm cases.
BWPS score of 25 to 45 may suggest an impending storm. A chest x-ray may be done
to assess heart failure. Head CT may help exclude a neurological cause in some
patients. An ECG is often done to monitor for arrhythmias
12. Treatment
Treatment of thyroid storm consists of supportive measures like intravenous (IV) fluids, oxygen, cooling
blankets, acetaminophen, as well as specific measures to treat hyperthyroidism. If any precipitating
factors, for example, infection, are present, that needs to be taken care of. Patients with thyroid storm
must be admitted to the intensive care unit with close cardiac monitoring and ventilatory support if
needed.Specific Strategic Steps for Treatment
1.Therapy to control increased adrenergic tone: Beta-blocker
2. Therapy to reduce thyroid hormone synthesis: Thionamide
3. Therapy to reduce the release of thyroid hormone: Iodine solution
4. Therapy to block peripheral conversion of T4 to T3: Iodinated radiocontrast agent, glucocorticoid,
PTU, propranolol
5. Therapy to reduce enterohepatic recycling of thyroid hormone: Bile acid sequestrant After initial
supportive measures, a beta-blocker should be started for any case of suspected thyroid storm.
Typically, propranolol 40 mg to 80 mg is given every 4 to 6 hours. Then, either a loading dose of
propylthiouracil (PTU) 500 mg to 1000 mg followed by 250 mg every 4 hours or Methimazole (MMI) 20
mg every 4 to 6 hours should be given. Propylthiouracil is favored because it has a small but additional
effect of blocking the peripheral conversion of T4 to T3. An hour after the administration of
propylthiouracil or Methimazole, give five drops of SSKI (supersaturated potassium iodide) by mouth
every 6 hours. Always administer thionamide before starting iodine solution (SSKI) therapy. This
prevents the imminent increase in thyroid hormone synthesis due to increased iodine load from super
saturated potassium iodide.
13. Treatment cont
Hydrocortisone 100 mg IV every eight hours (or Dexamethasone 2 mg every 6 hours) should also be started. If available, oral
cholestyramine 4 grams four times daily can be started for severe cases. One should look for precipitating factors and treat
them accordingly. The use of aspirin should be avoided due to its potential risk of increasing free thyroid hormone levels by
interfering with thyroid binding protein. In the first 24 hours of treatment, propylthiouracil decreases T3 level by 45%, but
Methimazole drops T3 level by only 10 % to 15%. Methimazole, whereas, causes more rapid normalization of serum T3 level
after a few weeks of treatment and it has less hepatotoxicity compared to propylthiouracil.
Therefore, after initial stabilization, we should treat with Methimazole (if propylthiouracil was started at the beginning, it
should be changed to Methimazole). For patients who cannot take oral antithyroid medicine, liquid preparation (pharmacist
may have to compound) can be given as enemas. Sometimes, pharmacists can prepare an IV form of antithyroid medicine by
dissolving the tablet. Esmolol, a short-acting beta-blocker, at a loading dose of 250 mcg/kg to 500 mcg/kg followed by 50
mcg/kg to -100 mcg/kg/minute can be given in ICU setting. For patients with reactive airway disease, cardioselective beta-
blockers like atenolol or metoprolol should be chosen. If there is a contraindication for the use of beta-blockers, diltiazem is
an alternative. If thionamide therapy is contraindicated because of an allergic reaction, thyroidectomy is needed after
treatment with a beta-blocker, hydrocortisone, cholestyramine, and iodine solution.
Plasmapheresis is the last resort if all other measures fail. Once patients’ clinical conditions improve, the iodine solution
should be stopped, glucocorticoids can be tapered and stop, and beta-blocker should be adjusted. Thionamide therapy
should be titrated, and if propylthiouracil is used initially, it should be switched to Methimazole. Patients should be
recommended for definitive treatment with radioiodine (RAI) therapy or thyroidectomy. Surgery may be required in patients
with grave's disease for the treatment of hyperthyroidism. These patients need to be pretreated with beta-blockers,
glucocorticoids, and iodine formulas. Surgery is usually done after 5-7 day
14. Differential diagnosis
Thyroid storm should be differentiated from other diseases of similar
symptoms and signs.[16] As fever is the most common presentation of
multiple diseases, so it can be misdiagnosed. The differential diagnosis are:
• Sepsis
• Infection
• Psychosis
• Cocaine use
• Pheochromocytoma
• Neuroleptic malignant syndrome
• Hyperthermia
15. Surgical Oncology
If toxic adenoma or multinodular goiter is causing this disease, then
surgical resection and radioactive iodine ablation are the mainstay of
treatment. Thyroidectomy is preferred if a patient has compressive
symptoms. Patients who refuse ablation or have contraindications to
surgery can be treated with long-term antithyroid medicines. Grave's
disease with intrathoracic mass causes severe compressive symptoms
and thyroidectomy is preferred in these cases. Thyroidectomy has
other adverse effects like recurrent laryngeal nerve damage and
hypoparathyroidism.
16. Radiation Oncology
If toxic adenoma or multinodular goiter is causing this disease, then
surgical resection and radioactive iodine ablation are the mainstay of
treatment. Thyroidectomy is preferred if a patient has compressive
symptoms. Patients who refuse ablation or have contraindications to
surgery can be treated with long-term antithyroid medicines.Grave's
disease with intrathoracic mass causes severe compressive symptoms
and thyroidectomy is preferred in these cases. Thyroidectomy has
other adverse effects like
• Recurrent laryngeal nerve damage
• Hypoparathyroidism
17. Pertinent Studies and Ongoing Trials
Randomized trials are still under process for efficacies and safety of
more medicines
18. Toxicity and Side Effect Management
Complete surgical resection of thyroid and radioiodine ablation can
cause hypothyroidism. So these patients need lifetime exogenous
thyroxine therapy and should be monitored for hyperthyroidism. Dose
adjustments by endocrinologists are crucial as the patient is at the risk
of both hypothyroidism and hyperthyroidism.
Antithyroid drugs, MMI and PTU, causes agranulocytosis. Patients on
these drugs should be monitored with CBCs especially white cell count.
If white cell count starts decreasing, these drugs should be
discontinued due to the increased risk of infection. Other toxicities are
hepatic failure, cholestasis, rash, gastrointestinal toxicity, and
musculoskeletal pains.
19. Prognosis
• Thyroid storm is a real medical emergency which is fatal if left
untreated. Cause of death may be heart failure, arrhythmias or
multiple organ failure. However, with treatment, most patients see an
improvement within 24 hours. Risk factors for poor prognosis include:
Advanced age
• Neurological deficits on admission
• Failure to use beta-blockers
• Antithyroid medications
• Need for dialysis and/or mechanical ventilation
20. Complications
If left untreated, thyroid storm can lead to the following complications:
• Arrhythmias
• High output cardiac failure Seizures
• Delirium
• Coma
• Elevated liver enzymes
• Jaundice Abdominal cramps
• Vomiting
• Diarrhea
• Atrial fibrillation and thromboembolism