Thyroid Crisis (thyroid storm, thyrotoxicosis, thyrotoxic crisis)

Is a severe hyperthyroidism, usually abrupt on set. It is a life-threatening health

condition that is associated with untreated or undertreated hyperthyroidism. During
thyroid storm, an individual's heart rate, blood pressure, and body temperature can
soar to dangerously high levels. Thyroid storm is a medical emergency condition
and needs to be treated immediately, even before all confirmatory diagnostic tests
are performed.
Etiology

Stress
Injury
Infection
Thyroid amd non thyroid surgery
Tooth extraction
Insulin reaction
Diabetic acidosis
Pregnancy
Digitalis Intoxication
Extreme emotional stress
Vigorous palpation on the thyroid

Pathophysiology
Located at the front part of the neck, the thyroid gland is responsible for making
substances (thyroid hormones) essential for all body cells to work properly.
In certain conditions, the thyroid becomes over-active and produces too much
thyroid hormone in the body, a state called hyperthyroidism. People with
hyperthyroidism have problems from over-activity of several organs, resulting in
symptoms such as sweating, feeling hot, rapid heartbeats, weight loss, and
sometimes eye problems. When thyroid hormone levels become very high, the
symptoms worsen and can result in a serious condition called thyroid storm or
thyrotoxic crisis. One major sign of thyroid storm that differentiates it from oridnary
hyperthyroidism is a marked elevation of body temperature, which may be as high
as 105-106 F (40.5-41.1 C). Thyroid storm is unusual, but is a life-threatening
emergency when it does occur. People experiencing symptoms of thyroid storm
should be promptly taken to an emergency department.

Clinical Manifestations

High fever (above 38.5)

Extreme tachycardia (more than 130 beats/min)
Exaggerated symptoms of hyperthyroidism with disturbances of a major
system- for example, GI (weight loss, diarrhea, abdominal pain)
Or cadriovascular (edema, chest pain, dyspnea, palpitations)
Altered neurologic or mental state (delirium psychosis, somnolence or coma)

Nursing Diagnosis

Imbalanced nutrition, imbalanced body requirements, related to exaggerated

metabolic rate, excessive appetite, and increased gastrointestinal activity
Ineffective coping related to irritability, apprehension and emotional
instability
Low self-esteem related to changes in appearance, excessive appetite and
weight loss

Complications
Irregular heart rhythms (arrhythmias) may occur. Heart failure and pulmonary
edema can develop rapidly and lead to death.
Laboratory Tests

The systolic (top number) blood pressure reading may be high, and the
diastolic (bottom number) blood pressure may be low
Heart rate is increased
Blood tests are done to check thyroid hormones TSH and T3.

Nursing Management

A hypothermia mattress or blanket, ice packs, a cool environment

Huminified oxygen is administered to improve tissue oxygenation and meet
high metabolic demands
Improving nutritional status
Improving self esteem
IVF is administered

Medical management

Hydrocortisone and aminophen (Tyenol)

PTU (propylthiouracil) - preventing the production of more T4 and T3 in the
thyroid, it blocks the conversion of T4 to T3 outside of the thyroid, resulting in
a rapid reduction in the level of circulating hormone. (oral)
Methimazole (Tapazole)- blocks the production of T4 and T3, but it does not
prevent T4 from converting to T3, so it takes longer to reduce the level of
circulating thyroid hormone. (oral)
Iodine
Propranolol
Thioureas (antithyroid thioamide medication)