Thyroid Storm(Thyrotoxic Crisis)

 Definition:

         This is a rare but severe complications of hyperthyroidism, which may occur when a thyrotoxic patient becomes very sick or physically stressed.

Symptoms include;

• Increased body temperature 🌡️ ( >40 degrees Celsius or 104 degrees Fahrenheit)
• Tachycardia
• Arrhythmia
• 🤮 Vomiting and diarrhea leading to dehydration
• Coma and death

Diagnostic/ Intervention:

1. Thyroid function test (TSH, T4, T3) TSH level-low, T3 and T4 - elevated 
2. Anti- TSH -receptor antibodies will be found in Grave's disease
3. Radioactive iodine uptake test and thyroid scan 
4. Radioactive iodine is injected or taken orally on an empty stomach and the amount of iodine absorbed by the thyroid gland is measured.
5. Patients with hyperthyroidism absorb too much iodine

Management:

Treatment depends on the cause and severity of symptoms.

Hyperthyroidism is usually treated with,

• Anti-thyroid medications
• Radioactive iodine ( which destroys the thyroid gland and stops the excess production of hormones)
• Surgery to remove the thyroid (After surgery or after radiation therapy the patient must take thyroid hormone replacement pills for the rest of life)
• Beta-blockers such as propranolol  used  to treat some of the symptoms, including rapid heart rate , sweating and anxiety until the hyperthyroidism can be controlled

Management of Thyroid Storm:

 The main treatment is to reduce the circulating thyroid hormone levels and decrease their formation.

1. Propyl thiouracil and methimazole are usually prescribed in high doses
2. Intravenous beta-blockers to reduce heart rate
3. Intravenous steroid 
4. Sodium iodide solution

Nurse's Interventions:

•  Monitor vitals
• Provide adequate rest
• Provide cool and quite environment
• Provide high calorie diet
• Obtain weight daily
• Administer anti-thyroid medications as prescribed
• Administer iodine preparations that inhibit the release of thyroid hormone as prescribed
• Administer propranolol for tachycardia as prescribed
• Prepare the patient for radioactive iodine therapy
• Prepare the patient for thyroidectomy if needed

In Thyroid Storm:

1. Maintain a patent airway and adequate ventilation
2. Administer antithyroid medications sodium iodide solution, propranolol and glucocorticoids as prescribed
3. Monitor vitals and assess continuously for cardiac dysrhythmias
4. Use a cooling blanket to decrease temperature as prescribed
5. Administer non-salicylate antipyretics as prescribed ( salicylate increase free thyroid hormone levels).
6. Thyroidectomy: Removal of thyroid gland. Thyroidectomy is the surgical management of hyperthyroidism.

Pre-Operative Care:

• Obtain informed consent
• Monitor vital signs and weight
• Assess for hypoglycemia
• Assess electrolyte levels
• Administer antithyroid medications, sodium iodide solution, propranolol and glucocorticoids as prescribed to prevent the occurrence of thyroid storm
• Instruct the patient in how to perform coughing and deep breathing exercises and how to support the neck in the postoperative period while coughing and moving
• Give mental support to the patient

Post Operative Care:

1. Monitor vitals and monitor respiratory distress
2. Have a tracheostomy set, oxygen and suction at the bedside
3. Maintain patient in a semi -Fowler's position
4. Monitor incision site for edema and  for signs of 🩸 bleeding . Check dressing ath the front and at the back of the neck
5. Advise to limit talking and assess level of hoarseness
6. Monitor for laryngeal damage as evidenced by respiratory obstruction, dysphonia,high- pitched voice, stridor, restlessness, and dysphagia
7. Monitor for signs of hypoglycemia and tetany, which can be caused by trauma to the parathyroid gland
8. Monitor for thyroid storm