* 2 Minutes Critical Care: Thyroid storm in ICU: When A storm is brewing! • Thyroid storm is a rare, but life-threatening disease that is important to recognize. • Thyroid storm accounts for 1-2% of hospital admissions for thyrotoxicosis. It is usually is an extreme manifestation of Grave’s disease or toxic multinodular goiter. • It is a deadly disease if unrecognized, with a 10-30% mortality. There are numerous case reports describing atypical presentations, involving all areas of critical care medicine. • Reports of thyroid storm presenting as status epilepticis, stroke, arrhythmia, jaundice, acute abdomen, and multi-system organ dysfunction can be found in the literature. • The diagnosis is clinical, and supported by a scoring system in which points are given for the degree and severity of clinical manifestations. • Shock in thyroid storm is probably multifactorial, and related to the combination of adrenal, cardiac, and liver dysfunction. In addition, insensible fluid losses from fever, diarrhea, and possibly underlying infection also may contribute to hypotension. • It is important to remember that in general, routinely testing thyroid function in the ICU is NOT recommended. TFTs usually reveal the euthyroid sick syndrome, with slightly low or normal TSH, and decreased T3 and T4. There is controversy to whether this syndrome reflects an adaptive or pathological change; however, routine treatment is not recommended. • Thyroid function testing should be pursued when there is a reasonable clinical suspicion that the patient’s primary problem is due to thyroid dysfunction. In addition, when a clinical scenario does not completely make sense, or when a patient fails to improve with the initial treatment plan, it should at least be considered as a potential cause of critical illness.
Posted on: Tue, 04 Nov 2014 22:21:48 +0000
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