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Endocrinologic Disorders

Management of Thyroid Crisis

Not yet clinically reviewed

This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.

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.