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Complications of Thyroid Surgery
Published in Madan Laxman Kapre, Thyroid Surgery, 2020
Gregory W. Randolph, Dipti Kamani, Cristian Slough, Selen Soylu
Patients undergoing thyroid surgery for hyperthyroidism are at risk of thyroid storm, a life threatening complication affecting multiple systems including the cardiopulmonary, thermoregulatory, metabolism, neurologic, and gastrointestinal systems [67]. Thyroid storm is associated with hyperthyroidism secondary to Graves’ disease and less often with toxic nodule or multinodular goiter [67]. This complication is believed to precipitate due to the stress of surgery, anesthesia, or thyroid manipulation during surgery [68]. Recognition and appropriate management of thyrotoxicosis is vital to prevent associated high morbidity and mortality.
Endocrine emergencies with skin manifestations
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Thyroid storm, also called accelerated hyperthyroidism, is an extreme accentuation of thyrotoxicosis. It is an emergency that if not treated in a timely fashion carries a high mortality rate. The common precipitating factors are infection, trauma, or surgical emergencies. Other conditions include diabetic ketoacidosis, toxemia of pregnancy, or parturition. The clinical signs include hyperpyrexia; cardiovascular decompensation leading to tachycardia, atrial fibrillation, and congestive heart failure; gastrointestinal dysfunction; and central nervous system disturbance in the form of delirium, seizures, and coma [12].
Surgical approach to thyroid disorders
Published in David S. Cooper, Jennifer A. Sipos, Medical Management of Thyroid Disease, 2018
Vaninder K. Dhillon, Ralph P. Tufano
In the preoperative evaluation of patients with Graves’, it is important to acknowledge the potential for thyroid storm. Thyroid storm is a life-threatening condition which leads to an excess release of thyroid hormone, often occurring in a suboptimally controlled hyperthyroid patient. Characterized by severe clinical manifestations of hyperthyroidism, symptoms include fever, gastrointestinal disturbances, tachyarrhythmias, congestive heart failure, agitation, and altered mental status (11; see Thyrotoxicosis chapter). The risk of thyroid storm is reduced by adequate preoperative preparation, initially with antithyroid medications followed by potassium iodide treatment for up to 10 days prior to surgery. An acute iodine load after pretreatment with thionamides reduces the thyroid vascularity and intraoperative blood loss (13). It is known that patients who are thyrotoxic prior to surgery have a higher mortality, but there is no compelling evidence to delay surgery for the sole purpose of adding iodine to decrease vascularity in patients otherwise adequately treated for their thyrotoxicosis (12, 13).
Mechanical circulatory support for thyrotoxicosis-induced cardiomyopathy
Published in Baylor University Medical Center Proceedings, 2023
Nikita Dhir, Travis Haneke, Timothy Mixon
Thyrotoxicosis is a serious condition that can lead to high-output heart failure and possible cardiogenic shock.1 It usually presents with extreme symptoms of hyperthyroidism, including tachycardia, fever, hypotension, agitation, nausea, vomiting, and/or diarrhea. Thyroid function tests will show high free T4 and T3, with low thyroid-stimulating hormone. Treatment for thyroid storm includes beta-blockers, iodine solution, thionamides, and glucocorticoids.2 Complications of heart failure can potentially require temporary mechanical circulatory support (MCS) with an Impella device or extracorporeal membrane oxygenation (ECMO).1 In patients with hemodynamic instability, beta-blockers are avoided to prevent worsening of high-output cardiac failure. MCS can be a useful bridging tool during the treatment of reversible causes of cardiogenic shock, such as thyroid storm.
Thyroid storm secondary to acute Streptococcus pyogenes pharyngitis
Published in Baylor University Medical Center Proceedings, 2022
Valeria Hanson, Subaina Naeem Khalid, Glenn Ratmeyer, Abu Baker Sheikh
The diagnosis of thyroid storm is based on clinical suspicion. The Burch-Wartofsky scale and the Japanese Thyroid Association scale are the point system methods that assess dysfunctional changes in the thermoregulatory, central nervous system, cardiovascular, and gastrointestinal-hepatic systems.5,7 Classical symptoms include hyperpyrexia with diaphoresis and tachyarrhythmias, which coincide with our patient's presentation, including elevated brain natriuretic peptide and liver function test levels that correspond with heart failure and liver dysfunction, respectively. Infection is deemed a significant trigger for developing thyrotoxicosis; however, the type of infectious organism is still unknown. Previous case reports suggest links with a few upper respiratory tract infections (H1N1, COVID-19, SARS-COV-2) with the onset of thyroid storm; however, literature is sparse.8–10
The neuropsychological outcomes of non-fatal strangulation in domestic and sexual violence: A systematic review
Published in Neuropsychological Rehabilitation, 2022
Helen Bichard, Christopher Byrne, Christopher W. N. Saville, Rudi Coetzer
First, the larynx can be obstructed, cutting off airflow to the lungs (i.e., asphyxiation, leading to hypoxia), which may continue after pressure has been lifted if the neck structure has been damaged (e.g., hyoid fracture). Second, jugular veins can be occluded, leading to venous congestion, increased intracranial pressure, decreased respiration, and possible pinpoint haemorrhage (petechiae). Third, there is risk of internal carotid artery occlusion, restricting blood flow to the brain (i.e., ischaemic). This is more likely to happen when the attacker is facing the victim. If pressure is at the base of the neck, vertebral arteries may also be affected. Again, this may continue once pressure has been removed if there has been arterial dissection. Fourth, there may be triggering of the carotid sinus reflex, leading to dysrhythmia, possible cardiac arrest, and thus further lack of blood to the brain (hypoxic-ischaemic). Finally, the thyroid gland can be damaged, resulting in possible ‘thyroid storm’, in which acute hyperthyroidism can cause congestive heart and multi-organ failure.