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The patient with acute endocrine problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Hyperthyroidism results from an excess of thyroid hormones (T3 and T4), with an exaggerated form being a thyroid crisis. A thyroid crisis (or storm) can be triggered by infection, surgery, trauma or any other acute episode (e.g., myocardial infarction, stroke and eclampsia), but fortunately, is very rare. An over-secretion of thyroid hormones will lead to a hypermetabolic state, resulting in hyperpyrexia, tachycardia, hypertension, agitation and tremors. The management is aimed essentially at reducing the effects of these hormones until the patient is stable. Drug therapy will include the use of: Beta-blockers such as metoprolol, to reduce sympathetic activity.Sedatives, such as chlorpromazine or haloperidol.Corticosteroids such as hydrocortisone, to inhibit the conversion of T3 to T4.Carbimazole, a specific anti-thyroid drug, inhibits enzymes that play a role in T3 and T4 production.Iodine is a specific antithyroid therapy used to inhibit thyroxine release and treat some forms of hyperthyroidism.
Obstetrics: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Raised free T4, T3. Suppressed TSH. TSH receptor-stimulating antibodies.Well-controlled outcome usually good. Untreated risk IUGR, prematurity, perinatal death. Thyroid crisis with heart failure. Retrosternal goitre.
Fever In Endocrinologic Disorders
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Ygal Gilboa, Elisabeth Horer, B. Isaac
The other clinical manifestations of the thyroid crisis are severe tachycardia or atrial fibrillation, congestive heart failure, severe perspiration, and diarrhea and vomiting leading to dehydration. Neuropsychiatrie manifestations are also present, manifested by anxiety, tremor, stupor, and even convulsions.
Hemodynamic Instability during Thyroidectomy in Graves’ Disease
Published in Journal of Investigative Surgery, 2022
Sami Acar, Candas Ercetin, Nuri Alper Sahbaz, Fırat Tutal, Yunus Yapalak, Fulya Cosan, Yesim Erbil
One of the main concerns during thyroid surgery is a thyroid crisis or storm, as this is a life-threatening situation. The prevalence of thyroid crisis is not fully known, but the early diagnosis of thyrotoxicosis findings is now revealing it to be less common than previously thought [14]. Thyrotoxicosis can be defined as a rapid increase in thyroid hormone levels, hyperthermia, tachycardia, and a predisposition to cardiovascular collapse (severe hypotension) [15]. Preoperative preparation of the patients is important in order to avoid a thyroid storm from the mixing of thyroid hormones into the circulation during the peri-operative period and to reduce postoperative complications [16]. When successful medical treatment of hyperthyroidism is applied in the preoperative period, almost no risk of a thyroid storm exists during elective thyroid surgery. Different modalities in use, with the most frequently preferred treatment modalities are ATDs, steroids and beta blockers, Lugol’s solution, lithium and plasmapheresis [17].
Pitfalls in the assessment of gestational transient thyrotoxicosis
Published in Gynecological Endocrinology, 2020
Surgically removing the HM rapidly ameliorates hyperthyroidism and, if possible, surgery should occur during early pregnancy [40]. Nevertheless, uncontrolled hyperthyroidism may develop into a thyroid crisis or cause serious arrhythmias perioperatively [41]. Patients require close observation for the first 24–48 h postoperatively, preferably in a high-dependency unit. Further, to exclude the presence of persistent trophoblastic tissue, thyroid function and beta-hCG levels should be monitored regularly until the hCG levels normalize.