It is a sudden acute exacerbation of all of the manifestations of thyrotoxicosis due to sudden release of large amount of thyroid hormones (Emergency syndrome).
Causes:
- Surgery (especially thyroid surgery) in patients with uncontrolled hyperthyroidism
- RAI (radioactive iodine)
- Discontinuation of anti thyroid drugs
- Acute illness (eg stroke or mycocardial infarction, infection, or exposure to an iodine load in patients with uncontrolled or partially treated hyperthyroidism.
MANIFESTATIONS :
- Fever with flushing and sweating
- Vomiting, diarrhoea.
- Tachycardia, arrhythmia (A.F.), occasionally HF and shock.
- Agitation, restlessness, delirium, coma (CNS manifestations).
- Even death from heart failure and shock.
Treatment
B-blockers:
- Propranolol 1 - 2 mg I.V. slowly or 40 - 80 mg oral / 6 hours.
- It can abolish or control excessive adrenergic response in C.V. system.
- 1 mg oral, I.M. or I.V or diltiazem 90 - 120 mg/kg t.d.s orally.
Iodides:
- 1-2 gm/day IV drips “NaI” or 10 drops orally of saturated “KI” / day to produce rapidly decreased in the release of hormones from the gland
- Following recovery iodide is discontinued gradually.
Propylthioueracil:
- 250 mg /6 hours orally or methimazole 25 mg / 6 hours IV to block hormone synthesis more rapidly than other thiouracil drugs.
Hydrocortisone:
- 200 mg I.V. / 6 hours.
- Protect patient against shock.
- Block the conversion of T4 to T3.
- Decrease the hormone release.
Supportive or symptomatic therapy
- Treatment of fever by cold fomentation
- Fluids, electrolytes and vasopressors for ttt of dehydration and hypotension.
- Phenobarbitone for treatment of convulsions
- Treatment of underlying disease which may have precipitated the acute storm.
Plasmaphorisis or peritoneal dialysis
- in rare severe cases to lower the level of circulating thyroxin.