Management of Thyroid Crisis

Clinical features

• Cardiovascular symptoms: Palpitations, tachycardia / tachyarrhythmias, cardiac failure / oedema.
• CNS symptoms: Anxiety / agitation, Violent outbursts, Psychosis / delirium, fitting / coma.
• Gl symptoms: Diarrhea, vomiting and jaundice.
• General symptoms: Fever, hyperventilation, Sweating and polyurea

Investigations

TFTS, BLIS, serum Calcium, ECG

Management

• Admit the patient and pass large bore IV line.
• Follow ABC protocol and cool the patient Inf- dextrose 5 % IV x stat (according to status of dehydration).
• In case of Atrial Fibrillation Inj- Digoxin (Lanoxin) 0.5mg diluted in in 5 % dextrose water / Normal saline over 20-30 min
• Inj- Dopamine or Dobutamine in 500 ml N / saline at the rate of 8-12 drops / min if there is shock.
• Tab- Propylthiouracil (Procarbizole) 50mg, 2-3 tablets PO x QID. During pregnancy the dose of propylthiouracil is kept below 200 mg / day to avoid goitrous hypothyroidism in the infant.
• Lugol's iodine (Potassium iodide ) 10 drops PO x TDS 1hour after Propylthiouracil.
• Tab - Propranolol (Inderal) 40mg, 1-3 tablets PO x QID ' OR ' 0.5-2 mg IV every four hours. Use cautiously in the presence of heart failure
• Inj - Hydrocortisone (Hyzonate) 50-100 mg , IV x QID
• Inj- Enoxaparin (Clexane) 40 mg S / C x OD Treatment of the precipitating factors such as infection with antibiotics Symptomatic therapy for other complaints
• Definitive surgery with radioactive iodine or surgery is delayed until the patient become euthyroid.

Note

T4 is measured every 2-4 days till it approaches normal range Hydrocortisone is then tapered and propylthiouracil is continued till the patient become normal.