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Medicine

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Endocrine

Question
17 out of 18
 

All of the following are associated with Thyroid storm, Except:



A Surgery for thyroiditis

B Surgery for thyrotoxicosis

C Stressful illness in thyrotoxicosis

D I131 therapy for thyrotoxicosis

Ans. A

Surgery for thyroiditis

1). Thyroid storm occurs in a thyrotoxic patient who has been inadequately prepared for thyroidectomy.

2). All options other than thyroiditis mentioned as options reflect a thyrotoxic state under stress and may lead to thyroid storm.

3). Thyroid storm is an extreme form of thyrotoxicosis that may occur with a variety of conditions.

4). Conditions that may lead to thyroid storm in thyrotoxic patients.

a. Stressful illness

b. Thyroid surgery for hyperthyroid without adequate pre-operation preparation

c. Radioactive iodine administration

Sign & symptoms: Severe hyperthyroidism: fever, agitation, confusion, coma, tachycardia, atrial fibrillation, diarrhea, vomiting, thyroid bruit, 'acute pain abdomen'.

Management plan for thyrotoxic storm


1). 0.9% saline

2). If no CHF, give propranolol

3). If there is heart failure give digoxin intravenous

4). Antithyroid drugs, propylthiouracil

5). After 4 hours give Lugol's solution 0.3mL/8h orally for 1wk to block thyroid hormone synthesis.

6). Hydrocortisone IV or dexamethasone IV

7). Treat infection with cefuroxime


Extra Edge:

1). Thyroiditis may not be necessarily associated with thyrotoxicosis.

2). In fact many forms of thyroiditis have associated hypothyroidism and hence these patients are unlikely to develop thyroid storm when taken for surgery.

Endocrine Flashcard List

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