In The Face Of The Storm – The Terror Which Is Thyroid Storm
There are very few anomalies of the thyroid that require immediate medical attention and one of them is the dreaded thyroid storm. It is a serious condition that could result in death in several hours without prompt medical attention.
What is It?
This is a serious condition wherein there is an aggravation of the symptoms of hyperthyroidism. It is hyperthyroidism but in its most severe, life-threatening form. In the past, this condition usually follows a recent surgery but now, it is mostly due to poorly treated or untreated infections.
What sets this condition apart from other forms of hyperthyroidism is the extremely high body temperature of patients with this condition. These patients may reach temperatures of as high 105-106F.
What Causes the Attack?
This sudden aggravation of hyperthyroidism, in the past, may follow a recent surgery but this has largely been eliminated by the development of modern preoperative procedures. This may happen in patients prepared for thyroid surgery with potassium iodide alone. A few weeks prior to administering iodides, a hyperthyroid patient must first be given doses of propylthiouracil or methimazole until basal metabolic rate is within normal levels.
Another cause of this acute hyperthyroid attack is an infection that has been poorly treated or remains largely untreated. Lung infections, especially, may produce an exaggeration of thyrotoxicosis. Other causes include noncompliance or stopping medications for hyperthyroidism, a high dose of thyroxine treatment for hypothyroid patients, treatment with radioactive iodine, pregnancy, and heart attacks and other heart attack emergencies.
What to Watch Out For
Most signs and symptoms of this sudden condition are exacerbated effects of hyperthyroidism. These include rapid heart beat, chest pains, shortness of breath, anxiety and irritability, disorientation, increased sweating, weakness and heart failure. The hallmark of this particular condition is an extremely increased body temperature. A patient may reach body temperatures of as high as 106F in the middle of the attack.
Sometimes, the attack takes on another turn wherein the patient may experience extreme weakness, emotional apathy and confusion. The high excitability and delirium of usual thyroid storm patients is not evident and fever may not even be rise as high. This is called apathetic storm.
Intervention
This particular state of hyperthyroidism takes on suddenly and a patient may not be able to help himself once it sets in. It is important that family members or anybody bring the patient to a hospital for immediate treatment. This condition constitutes a medical emergency and it is only through prompt recognition of the signs and aggressive medical treatment that mortality due to this particular disease has been decreased.
The patient is advised to rest and may necessitate mild sedation. Fluids and electrolytes may be replaced intravenously and vitamins and nutritional support may be needed. Antibiotics may also be given if an infection is found to be the cause of the episode.
Other specific therapy given to thyroid storm patients include propanolol, antithyroid drugs such as propylthiouracil and methimazole, large doses of potassium iodide, and dexamethasone. Most of these drugs serve to lower the thyroid hormone in circulation and prevent further production and secretion of thyroid hormone.
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