Thyrotoxic crisis

Clinical applications include preoperative suppression of thyroid secretion according to Plummer with Lugol s solution (5% iodine + 10% potassium iodide, 50-100 mg iodine/d for a maximum of 10 d). In thyrotoxic crisis, LugoTs solution is given together with thioamides and p-blockers. Adverse effects allergies contraindications iodine-induced thyrotoxicosis. 

Iodine is used pre-operatively and in the management of thyrotoxic crisis. It temporarily inhibits proteolysis of thyroglobulin and prevents the release... 

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. 

Unlabeled Uses Cerebral vasospasm, migraines, Raynaud s syndrome, reflex sympathetic dystrophy, refractory depression, tardive dyskinesia, thyrotoxic crisis. 

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. 

Extensive iodine absorption from povidone-iodine can cause transient hypothyroidism or in patients with latent hypothyroidism the risk of destabilization and thyrotoxic crisis (SEDA-20, 226 SEDA-22, 263). Especially at risk are patients with an autonomous adenoma, localized diffuse autonomy of the thyroid gland, nodular goiter, latent hyperthyroidism of autoimmune origin, or endemic iodine deficiency (51). 

Antithyroid drugs may also suppress lymphocytic infiltration into the thyroid and thereby directly modulate the basic disorder of autoimmune hyperthyroidism (SEDA-6, 364 SEDA-9, 344). Propylthiouracil, but not the thioimidazoles, also inhibits the conversion of thyroxine to its more active derivative triiodothyronine. This effect is significant during high-dose treatment, and propylthiouracil may therefore be preferred if a more rapid onset of action is desired, for example thyrotoxic crisis, although clear experimental proof of the advantageous effect is still lacking (3). 

The possibility of inducing thyrotoxic crisis after the intravascular use of iodinated contrast media in patients with thyroid carcinoma and thyrotoxicosis has been reemphasized (574). 

Jones DK, Solomon S. Thyrotoxic crisis masked by treatment with beta-blockers. BMJ (Clin Res Ed) 1981 283(6292) 659. 

Calvo Romero JM, Puerto Pica JM. Crisis tirotoxica tras la retirada de tratamiento con litio. [A thyrotoxic crisis following the withdrawal of lithium treatment.] Rev Clin Esp 1998 198(ll) 782-3. 

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. 

Lithium withdrawal may be associated with an outpouring of thyroid hormone in predisposed individuals there have been reports of thyrotoxicosis (274) and a thyrotoxic crisis (274) after lithium withdrawal. 

Propylthiouracil, a thyroid hormone antagonist, is used in hyperthyroidism, in thyrotoxic crisis, and in preparation for thyroidectomy (see also Figure 66). 

Long-term therapy is contraindicated, because iodides will cross the placenta and into breast milk, causing hypothyroidism (goiter) in the fetus and neonate. Short, intensive therapy for thyrotoxic crisis may be utilized without adverse effects to the fetus. 

To prepare hyperthyroid patients for thyroid surgery, thyrotoxic crisis, thyroid blocking in radiation therapy... 

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

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