THYROID STORM PRESENTATION
Fever
Altered mental status
Tachycardia
CAUSES
Infection
MI
DKA
Pregnancy
Trauma
Untreated thyroid disease
Ingestion of thyroid hormone
TREATMENT
Control body temperature
Cool IV fluids, external cooling
IV Fluids
High output cardiac failure- preload dependent
Add glucose as they have low glycogen stores
Beta Blocker
Propranolol 0.5- 1mg IV over 3-5 minutes
Prevents conversion of T4àT3
Non selective beta blocker
Titrate to HR<100
Stop Thyroid hormone synthesis
Propylthiouracil 1000mg PO/NG or PR
Preferred in pregnancy
Prevents conversion of T4àT3
Hydrocortisone 100mg IV q 8
Blocks T4àT3
Thyroid storm causes depression of hypothalamic- pituitary axis
Iodine
Inhibits thyroid hormone release
Do not give for at least 1 hour after starting PTU
Antibiotics