sob, palpitation, diarrhea, weight loss and orthopnea
Diagnosis:
thyroid storm
It is clinical diagnosis
Supportive score:
Burch-wartofsky point scale
Other possible presentation:
as atrial fibrillation and ischemic stroke
O/E: heart rate 140. Blood pressure 140/90
Chest crackles
LE edema
Labs:
TSH 0.001. FT4 56
Other test?
ANTI-TSH antibody
Differential diagnosis:
• Causes of hyperthyroidism
1. Grave’s disease
2. MNG
3. Toxic thyroid adenoma
4. Inflammation of thyroid like sub acute thyroiditis
5. Drugs like amiodarone or excess levothyroxine
6. Postpartum thyroiditis
7. Struma ovarii
8. Hyper secretion of TSH by pituitary adenoma
Remember to rule out infectious causes, precipitative causes
Management:
ABC, …
Cardiac monitor
ICU consult
Beta blocker :
• propranolol, typically 60 to 80 mg orally every 4 to 6 hours
potassium iodide or lugol’s iodine
Anti thyroid medications
Steroid ( hydrocortisone ), intravenously, 300 mg loading dose, then 100 mg every eight hours
Cholestyramine (4 g orally four times daily) may also be of benefit
in severe cases, especially if the patient is allergic to
thionamides
Surgery
Follow up?
Check FT4 , T3
Tapper and d/c steroid
Stop beta blocker if normal TFT
Consider radio iodine or surgery for grave’s disease
