Thyroid crisis/storm

Occasionally patients develop a dramatically acute and severe form of thyrotoxicosis which may be life-threatening, termed thyroid crisis or thyroid storm. In this condition the patient is at risk of cardiac complications, notably arrhythmia and ventricular failure, and it requires very urgent treatment. It is essential to use high doses of anti-thyroid drugs, and PTU is often preferred for this, particularly because of its fast absorption. Iodides or ipodate are often... 

Sodium iodide Administer IV for thyroid crisis (thyroid storm), which is a severe symptom of hyperthyroidism... 

Thyrotoxic crisis, thyroid storm, or accelerated hyperthyroidism is an extreme accentuation of thyrotoxicosis. Although uncommon, this serious complication of hyperthyroidism usually occurs in association with Grave s disease and occasionally with toxic multinodular goiter. 

The most serious complication of hyperthyroidism is thyroid storm (thyrotoxic crisis). This is an acute exacerbation of hyperthyroidism with marked tachycardia, fever, mental status changes and haemodynamic collapse. It is usually precipitated by acute illness, trauma, parturition or surgery, especially of the thyroid gland. The mortality rate is 20-30%, even with aggressive treatment, due to cardiac failure, arrhythmias or hyperthermia. 

The imidazoles methimazole [60-56-0] (MMI) (12) and Carbimazole [22232-54-8] (13) act by inhibiting intrathyroidal hormone synthesis, whereas the thiouracils (10) [51-52-5] and (11) [56-04-2] also inhibit the peripheral deiodination of T4 to T3. Thus, the latter are preferred in the treatment of thyroid storm (thyrotoxic crisis) where a quick drop in circulating T3 is desired (2,9). In general, the imidazoles are 10 times as active as the thiouracils. 

I. preparation of patients for surgery, thyroid storm (crisis), exophthalmos... 

Iodide (large dose) is used for thyroid storm (crisis) and in preparation for thyroidectomy because it rapidly benefits the patient by reducing hormone release and renders surgery easier and safer (above). 

What therapy should be considered if thyrotoxic crisis (thyroid storm) occurs ... 

In patients with a poor or delayed response to antithyroid drugs, in elderly patients, pregnant women, or in patients with neurologic symptoms of thyrotoxicosis (incipient thyroid storm), early thyroidectomy is the treatment of choice, especially in IIH and when high-dose thionamides, glucocorticoids and intensive care fail to improve the patients conditions within 24h. Thyrotoxic crisis occurs in about 1% of all patients admitted to hospitals for hyperthyroidism Schaaiet al., 1990). 

Iodides have. several poorly understood actions on the thyroid. They inhibit organitication and hormone release. In addition, iodide de-crca.scs the size and vascularity of the hyperplastic gland, effects which are useful in the preparation of patients for thyroidectomy. In phamia-cological dose.s. the main effect of iodides is to inhibit hnmtone release (possibly by inhibition of thywglobulin proteolysis) and. because thyrotoxic symptoms are reduced relatively quickly (2 7 days), iodine is valuable in the treatment of thyrotoxic crisis ( thyroid storm —a life-threatening acute exacerbation of all the symptoms of thyrotoxicosis). Iodine caimoi be used for the long-term treatment of hyperthyroidism because its antithyroid action tends to diminish. 

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