USMLE/COMLEX - Step 2 - Thyroid Storm

USMLE/COMLEX - Step 2 - Thyroid Storm Excessive production and release of the thyroid hormone increase metabolic rate, which can cause a range of symptoms, including tachycardia, hypertension, hyperthermia, and multiple organ dysfunction. The sympathetic nervous system is also activated, leading to sympathetic overdrive and further contributing to the development of symptoms. Other hormonal imbalances, such as elevated levels of cytokines and catecholamines, may also play a role in the pathophysiology of thyroid storm. Fever Palpitations Tremors, muscle weakness, and fatigue Sweating and heat intolerance Agitation, confusion, and restlessness Nausea, vomiting, and diarrhea Jaundice and liver failure Difficulty breathing Altered mental status Hyperthermia Tachycardia Hypertension > 180/110 mmHg Tremors Difficulty breathing and respiratory distress Altered mental status Coma and shock Thyroid function tests: serum TSH, free T4, and T3 Electrolyte panel: sodium, potassium, and calcium levels Liver function tests Cardiac biomarkers: troponin and BNP chest X-ray, ECG, and echocardiography Inflammatory markers: CRP and procalcitonin The management of thyroid storm requires a multidisciplinary approach and may include the following: 1. Admission to an intensive care unit (ICU) for close monitoring and management. 2. Use anti-thyroid medications such as propylthiouracil (PTU) or methimazole (MMI) to inhibit thyroid hormone synthesis. 3. Administration of beta-blockers such as propranolol or esmolol to control tachycardia and hypertension. 4. Correction of electrolyte imbalances and fluid resuscitation to manage dehydration and prevent cardiovascular complications. 5. Use glucocorticoids such as hydrocortisone or dexamethasone to suppress the release of thyroid hormone. 6. Treatment of any underlying infection or trigger that may have precipitated thyroid storm. 7. Cooling measures such as ice packs and cooling blankets to manage hyperthermia. 8. Correction of any metabolic acidosis and respiratory failure that may occur. 9. Use plasmapheresis or hemodialysis in severe cases of thyroid storm with renal failure or liver failure. 10. Consideration of definitive treatment for hyperthyroidism, such as radioactive iodine therapy or surgical removal of the thyroid gland, after the patient has stabilized.