1. Thyroid Storm

2.  Thyroid storm (also know as thyrotoxic crisis) is an acute state of hyperthyroidism where all of the signs and symptoms are exaggerated.  It can be life threatening but with quick response can be controlled and managed

3. Triggers  Trauma  Infection  Surgery

4. Thyroid Storm  Treatment is largely symptomatic and etiology dependent  Look back at the treatments in your hyperthyroid module  Think also about the body’s functioning and the exaggerated symptoms of hyperthyroidism that would be manifested during thyroid storm

5. Storm Treatments Treatments directed at thyroid gland and hormones  Inhibition of new hormone synthesis with Thioamide drugs such as PTU and methimazole  Inhibition of hormone release with Iodine & potassium iodide (Lugol’s solution) & Lithium carbonate

6. What the heck is Lugol’s solution?  Also known as Lugol’s iodine, this oral solution is specifically indicated for patient’s with thyroid storm or preoperatively for a patient with hyperthyroidism  It is a mix of iodine, potassium iodide and distilled water  It is also used to enhance color and growth for coral in home aquariums!

7. Storm Treatments Treatments directed at preventing hormone’s affects on the body  Polythiouracil (PTU)  Corticosteroids  Beta blockers (most importantly Propanolol)  Amiodarone  Plasmapheresis

8. Storm Treatments Treatments directed at maintaining homeostasis  Hyperthermia: acetaminophen, cooling blankets  Fluid and electrolyte testing/replacement  Glucose  Vasopressors  Digoxin & diuretics if appropriate

9. Treatment Summary Overall Goal: Reduce circulation thyroid levels and control symptom  Beta blockers; decreases adrenergic hyperactivity (sympathetic outflow)  PTU (large amounts): prevents synthesis of the hormone  Glucocorticoids: inhibit hormone production and decrease peripheral conversion from T4 to T3.  Sodium iodide solution (Lugol’s solution): High levels of iodide will initially suppress release of thyroid hormone  Treat cardiac symptoms, fever and hypertension

10. Nursing Functions  Initiate cardiac monitoring, have code supplies ready if cardiac symptoms worsen  Monitor hemodynamic, respiratory & thermic parameters to ensure that therapies are working (homeostasis)  Keep patient safe and re-orient if acutely confused or highly anxious  Identify trigger and treat/remove