Thyroid storm
1. Which of the following is the most specific precipitating factor for thyroid storm?
Explanation: RAI therapy can trigger sudden hormone release and is a recognized precipitant of thyroid storm, especially in untreated Graves’ disease.
2. Which clinical feature most strongly suggests thyroid storm over uncomplicated thyrotoxicosis?
Explanation: Hyperpyrexia is a hallmark of thyroid storm, typically absent in regular thyrotoxicosis.
3. What is the primary cause of death in untreated thyroid storm?
Explanation: Cardiovascular collapse due to arrhythmias or heart failure is the leading cause of death in thyroid storm.
4. Which lab parameter is usually suppressed in thyroid storm?
Explanation: TSH is markedly suppressed in thyroid storm due to extreme negative feedback from high thyroid hormone levels.
5. Which scoring system is commonly used to diagnose thyroid storm?
Explanation: The Burch-Wartofsky scoring system helps quantify the likelihood and severity of thyroid storm.
6. Which of the following drugs is used to block peripheral conversion of T4 to T3 in thyroid storm?
Explanation: Both propranolol and propylthiouracil inhibit peripheral conversion of T4 to T3, but propranolol offers rapid adrenergic control as well.
7. What is the preferred thionamide in thyroid storm?
Explanation: PTU is preferred due to its additional effect of inhibiting peripheral conversion of T4 to T3, which is critical in storm management.
8. Which of the following agents should be administered at least 1 hour after thionamides?
Explanation: Iodine should be given after thionamides to prevent iodine from being used for new hormone synthesis (“Jod-Basedow” phenomenon).
9. Which corticosteroid is commonly used in thyroid storm treatment?
Explanation: Hydrocortisone is used to manage adrenal insufficiency and reduce T4 to T3 conversion.
10. Why are beta-blockers essential in thyroid storm?
Explanation: Beta-blockers like propranolol reduce adrenergic symptoms and inhibit peripheral T4 to T3 conversion.
11. What is the mortality rate of untreated thyroid storm?
Explanation: Mortality exceeds 30% without aggressive treatment, highlighting the need for rapid intervention.
12. Which ECG abnormality may be seen in thyroid storm?
Explanation: Atrial fibrillation is common due to increased adrenergic stimulation in thyroid storm.
13. Which GI symptom is common in thyroid storm?
Explanation: Increased gut motility results in diarrhea in patients with thyroid storm.
14. Which of the following symptoms suggests CNS involvement in thyroid storm?
Explanation: Delirium, agitation, and coma may occur due to CNS overactivation and dysfunction in severe cases.
15. Which of the following indicates hepatic dysfunction in thyroid storm?
Explanation: Liver enzymes may rise due to the systemic stress and direct effects of excess thyroid hormone.
16. Which is the earliest step in managing suspected thyroid storm?
Explanation: Initial stabilization in ICU with supportive care (airway, fluids, temperature) is crucial before specific treatment.
17. Which thyroid condition most commonly precedes thyroid storm?
Explanation: Graves’ disease is the most frequent underlying disorder associated with thyroid storm.
18. Which of the following is contraindicated before thionamide therapy?
Explanation: Iodine given before thionamides can increase hormone synthesis via the Wolff-Chaikoff escape; always give after thionamides.
19. Which electrolyte imbalance may complicate thyroid storm?
Explanation: Bone turnover and GI losses can cause mild hypercalcemia in severe thyrotoxicosis.
20. What is the role of cholestyramine in thyroid storm?
Explanation: Cholestyramine helps lower thyroid hormone levels by interrupting their reabsorption in the gut.
| 🔢 No. | Thyroid Crisis🩺 Key Point |
|---|---|
| 1 | Thyroid storm is a life-threatening exacerbation of thyrotoxicosis. |
| 2 | Common triggers: infection, surgery, trauma, childbirth, and RAI therapy. |
| 3 | Classic features: hyperpyrexia, tachycardia, CNS dysfunction, GI symptoms. |
| 4 | CNS signs may include agitation, delirium, or coma. |
| 5 | Burch-Wartofsky Score helps diagnose thyroid storm (score >45 = likely). |
| 6 | TSH is suppressed; free T3 and T4 are elevated. |
| 7 | Atrial fibrillation is a common ECG finding. |
| 8 | GI symptoms include nausea, vomiting, and diarrhea. |
| 9 | PTU is preferred over methimazole in thyroid storm. |
| 10 | PTU inhibits thyroid hormone synthesis and peripheral conversion (T4→T3). |
| 11 | Propranolol reduces adrenergic symptoms and T4→T3 conversion. |
| 12 | Iodine (e.g., Lugol’s) should be given 1 hr after thionamide. |
| 13 | Hydrocortisone is used to treat relative adrenal insufficiency. |
| 14 | Supportive care (ICU, fluids, cooling) is the first step in management. |
| 15 | Cholestyramine may lower hormone levels by interrupting enterohepatic cycle. |
| 16 | Liver dysfunction with elevated transaminases may occur. |
| 17 | Hypercalcemia and hyperglycemia can be seen. |
| 18 | Most cases are due to underlying Graves’ disease. |
| 19 | Mortality exceeds 30% without prompt treatment. |
| 20 | Beta-blockers and steroids are essential alongside antithyroid drugs. |
Thyroid crisis
Also known as thyrotoxic crisis – It is a rare and life-threatening complication of hyperthyroidism. It happens when the thyroid gland releases a large amount of thyroid hormone in a short amount of time, causing the body’s metabolism to go into overdrive, which can be extremely dangerous.
Causes and triggers
Usually triggered by a sudden and intense event in individuals with diagnosed or undiagnosed hyperthyroidism. Common triggers include:
- Stopping antithyroid medications suddenly.
- Surgery (thyroid or non-thyroidal).
- Trauma or infection.
- Acute illnesses like diabetic ketoacidosis, heart failure, or drug reactions.
- Exposure to large amounts of iodine (e.g., from certain imaging procedures).
- Giving birth.
- Stroke.
Symptoms
Symptoms are a severe exaggeration of hyperthyroidism symptoms, and can include:
- High fever (often 104-106°F or higher).
- Rapid heart rate (tachycardia) that may exceed 140 beats per minute.
- Agitation, irritability, and anxiety.
- Delirium or psychosis.
- Heart failure.
- Loss of consciousness.
- Less common symptoms include severe nausea, vomiting, diarrhea, abdominal pain, and jaundice.
Diagnosis and treatment
Diagnosis of is primarily based on clinical symptoms rather than laboratory findings, as waiting for test results can delay life-saving treatment. Treatment involves:
- Supportive measures such as oxygen, IV fluids, cooling blankets, and fever reducers.
- Antithyroid medications like propylthiouracil (PTU) or methimazole to block hormone synthesis.
- Iodine preparations (given at least an hour after antithyroid medication) to block hormone release.
- Beta-blockers to manage cardiovascular symptoms.
- Glucocorticoids to reduce peripheral T4 to T3 conversion and address potential adrenal insufficiency.
- Bile acid sequestrants to prevent reabsorption of free thyroid hormones in the gut.
- Treating the underlying cause that triggered the storm.
- Plasmapheresis may be considered in rare, resistant cases.
This is a medical emergency requiring immediate attention and hospitalization, often in an intensive care unit (ICU).
Prognosis
This is fatal if left untreated. Even with treatment, the mortality rate is estimated to be between 8% and 25%. With prompt and adequate treatment, clinical improvement is often seen within 24 hours. The crisis typically resolves within a week. Risk factors for a poor prognosis include advanced age, central nervous system (CNS) dysfunction, failure to use beta-blockers and antithyroid medications, and the need for dialysis or mechanical ventilation.
If you suspect – seek immediate medical attention by calling emergency services or going to the nearest hospital.
Thyroid crisis
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