Thyroid storm
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1) Thyroid storm, or a thyrotoxic crisis, is a life-threatening exacerbation of hyperthyroidism caused by an abrupt release of thyroid hormones into circulation. 2) It presents with fever, tachycardia, arrhythmias, heart failure, tremors, and gastrointestinal issues like nausea and vomiting. 3) Treatment involves controlling adrenergic symptoms with beta blockers, treating the underlying thyroid abnormality with antithyroid drugs like PTU, and providing supportive care like fluids and electrolyte replacement.
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2. Hyperthyroidism occurs in 0.2% of pregnancies, often due to Graves' disease. It increases risk of complications. Hypothyroidism occurs in 2-3% and also increases risks if not treated.
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2) It is classified as permanent or transient, with permanent CH caused by thyroid dysgenesis, defects in hormone synthesis, TSH resistance, or central hypothyroidism.
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1. It is a preventable cause of mental retardation that occurs in 1 in 3000-4000 live births worldwide and 1 in 2500-2800 in India.
2. The most common cause is thyroid dysgenesis, which accounts for 75-80% of cases.
3. Newborn screening programs allow for early detection and treatment to prevent morbidity, particularly neurodevelopmental disabilities.
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This document provides an overview of thyroid function and disorders during pregnancy. It discusses how the thyroid gland and thyroid function tests change normally during pregnancy. It also covers hyperthyroidism and hypothyroidism in pregnancy, including their effects on the fetus and neonate. Key points include that both hyperthyroidism and hypothyroidism can lead to adverse pregnancy outcomes if not properly treated, and maternal thyroid antibodies can affect the fetal thyroid gland. Precise diagnosis and treatment of thyroid disorders is important for maternal and fetal health.
Thyroid Noudle
- Thyroid nodules are very common, found in 4-7% of people on physical exam and almost 50% on ultrasound, with most people having multiple nodules. Thyroid cancer is found in 5-10% of palpable nodules.
- Factors that increase cancer risk include nodule size over 3 cm, male sex, radiation exposure, family history of thyroid cancer, and symptoms of local invasion. Features suggesting benign nodules include a family history of autoimmune disease and benign nodules.
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Hemolytic uremic syndrome
Hemolytic uremic syndrome (HUS) is a disease characterized by hemolytic anemia, low platelet count, and kidney failure. It predominantly affects children and can be caused by infections from E. coli or pneumococcal bacteria or complement factor abnormalities. The typical pathophysiology involves Shiga toxin or other bacterial toxins damaging endothelial cells and platelets. Treatment involves supportive care, antibiotics for infections, plasma therapy for complement abnormalities, and long-term prognosis depends on severity and treatment.
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Anaesthetic mgt for pt with hyperthyroidism pritam
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Thyroid storm
- 1. الرحیم الرحمن هللا بسم BY: DR LAILMAAH HABIBI 3RD year trainee of KABUL RBH 2017 1
- 2. By: Dr. Lailmaah Habibi MANAGEMENT OF THYROID CRISIS OR THYROID STORM
- 3. Objectives Definition Clinical manifestation Lab evaluation Medication 3
- 4. Thyrotoxic crisis or thyroid storm A life threatening exacerbation of hyperthyroidism due to abrupt release of T4 &T3 into circulation
- 5. Causes Sepsis Surgery Anesthesia induction RAI 𝑇𝑋 & Drugs ↑TH ingestion Withdrawal of AT drugs DKA Direct trauma Vigorous palpation Toxemia of pregnancy & labor in older adolescents; molar pregnancy Burns parturation
- 6. Clinical features Fever + Tachycardia Most common Fever: Most characteristic >41 C CVS: • Tachycardia • AF • V arrhythmia • HF • Hypertension(early) • Hypotension (late)
- 7. Neuromuscular: Tremors Encepalopathy Weakness Can progress to CVA/ Status epilepticus/Thyrotoxic myopathy/Rhabdomyolysis
- 8. GI: Nausea/ Vomiting/ Diarrhea Jaundice RS Dyspnea ↑𝑂2 consumption pulmonary oedema/ respiratory muscle weakness and tracheal obstruction from goitre
- 9. Diagnosis Hx of thyrotoxicosis Burch and Wartofsky criteria General Sx: GI Sx:. Neurologic sx
- 10. Lab testing: ↑FT3/FT4 Hyperglycemia Leucocytosis Abnormal LFT ↓K/Mg ; ↑ Ca
- 11. Management: 𝑇𝑥 aimed at: – Ctrl of adrenergic 𝑠 𝑥 – Ctrl of thyroid function abnormality – Stopping Ppt factor – Investigation & 𝑇𝑥 thyroid disease – Supportive measures
- 12. Beta blockers Mainstay of controlling adrenergic symptoms • propanolol • Esmolol
- 13. Thionamides: – PTU- Drug of choice – Methimazole Iodine: – Iodine/Lithium – given only 1hr after Thionamides – SSKI -10 drps Q8h
- 14. Amidarone Bile acid sequesterants: • Cholestyramine(4g Q6h) Steroids: • Hydrocortisone 100mg Q8h • Dexa 4mg iv Q6h
- 15. Supportive 𝑇𝑥: – Hyperthermia – Fluid and electrolyte testing/replacement – Nutrition – Drug 𝑇𝑥: salicylates AVOIDED – Precipitating factors – complication (Digoxin, diuretic, anticoagulation & vasopressor if appropriate)
- 18. Thank you
Editor's Notes
- c