The patient with acute endocrine problems
Peate Ian, Dutton Helen in 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.
Surgical approach to thyroid disorders
David S. Cooper, Jennifer A. Sipos in Medical Management of Thyroid Disease, 2018
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).
Surgical Endocrine Emergencies
Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba in Acute Care Surgery and Trauma, 2016
Thyroid hormones, prohormone thyroxine (T4) and triiodothyronine (T3), alter gene expression by systemically binding to mitochondrial and nuclear deoxyribo nucleic acid (DNA)-binding proteins, promoting metabolism and growth. Symptoms and signs of thyroid storm include fever, palpitations, atrial fibrillation, tachypnea, congestive heart failure (CHF), diarrhea, vomiting, jaundice, delirium, seizures, and coma [16]. Serum T4 and T3 levels are markedly elevated. Thyroid-stimulating hormone (TSH) is suppressed, unless the source of hyperthyroidism is due to a TSH-secreting pituitary tumor [15]. Additional laboratory abnormalities may include leukocytosis, elevated liver enzymes, elevation in lactate dehydrogenase, metabolic acidosis, and hyperglycemia [16].
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].
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.