| ID | 64 |
|---|---|
| Name | THYROTOXIC CRISIS |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigation: Full blood picture, electrolyte, blood glucose, serum thyroxine and serum tri-iodothyronine. |
| Management | Management: 1. Rehydration by i.v fluid. 2. Cooling of the patient by ice pack. 3. O2 inhalation 4. Propranolol 80mg orally 6 hourly or l-5mg i.v 6 hourly. 5. Sodium iopodate 500mg/day orally or lugol’s iodine 10 drops 8 hourly. 6. Carbimazole 15mg 8 hourly daily. 7. Hydrocortisone 50mg i.v 6 hourly, then rapid reduction of the dose when clinical condition improves. 8. If cardiac failure develops: diuretic should be used. 9. In case of uncontrolled atrial fibrillation digoxin should be given. N.B: Sodium iopodate & propranolol can be withdrawn after 10-14 days & patient should be maintained on propranolol. |
| Introduction | Thyrotoxic crisis is a rare but life-threatening complication of thyrotoxicosis. It usually develops in patients- i. when unrecognised or inadequately treated thyrotoxicosis (hyperthyroidism) is precipitated by infection; or, ii. following subtotal thyroidectomy in cases of ill-prepared patients; or, iii. following radioiodine therapy (if the patient gland has not been suppressed beforehand with iodine), an acute irradiation damage may lead to a transient rise in serum thyroid hormone levels; or, iv. when thyrotoxicosis is complicated by diabetic ketosis; or, v. when anti-thyroid drugs are prematurely stopped. |
| History | |
| Etiology | Etiology: As stated above. |
| Clinical Features | Clinical features: Tachycardia, hyperpyrexia, vomiting, shock, dehydration, cardiac failure, breathlessness, anxiety, tremor, severe eyelid retraction, uncontrolled atrial fibrillation. Thyroid gland enlarged and hyperactive |
| Preventions | |
| Treatment | |
| Complications | |
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