Thyroid Storm: Signs, Treatment and Nursing Care
Thyroid storm explained in question-and-answer form: 78 original questions on recognition, scoring, treatment order and nursing care, each answered from and quoted from the StatPearls Thyroid Storm chapter, the NIDDK hyperthyroidism page or MedlinePlus. For study, not for bedside decisions.
Original Q&A explainer on thyroid storm: what it is, triggers, signs, Burch-Wartofsky scoring, first nursing actions, the drug order and the reason behind each step.
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01What is thyroid storm?
An acute, life-threatening complication of hyperthyroidism: an exaggerated form of thyrotoxicosis with sudden multisystem involvement.
VERIFIED AGAINST THE SOURCE
“It is an exaggerated presentation of thyrotoxicosis, and it comes with sudden multisystem involvement.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗02What other names are used for thyroid storm?
Thyrotoxic crisis, or thyroid crisis. MedlinePlus describes it as a sudden worsening of hyperthyroidism symptoms that may occur with infection or stress.
VERIFIED AGAINST THE SOURCE
“Thyroid crisis (also called thyroid storm) is a sudden worsening of hyperthyroidism symptoms that may occur with infection or stress.”
— MedlinePlus Medical Encyclopedia (National Library of Medicine, NIH) ↗03Roughly how deadly is thyroid storm even with modern treatment?
Mortality is estimated at 8 to 25 percent despite modern treatment and supportive care, which is why early recognition and aggressive treatment matter.
VERIFIED AGAINST THE SOURCE
“Thus, it is very important to recognize it early and start aggressive treatment to reduce mortality.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗04Is thyroid storm diagnosed mainly by lab values or by the clinical picture?
By the clinical picture. The diagnosis is clinical, and scoring systems only guide clinical judgment.
VERIFIED AGAINST THE SOURCE
“These scoring systems are just guidelines. The actual diagnosis is based on clinical judgment.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗05Should treatment of suspected thyroid storm wait until thyroid lab results return?
No. Treatment should start without waiting for lab results.
VERIFIED AGAINST THE SOURCE
“One should not wait for lab results before starting treatment.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗06What thyroid function test pattern is usually seen in thyroid storm?
High free T4 and/or free T3 with a low TSH.
VERIFIED AGAINST THE SOURCE
“Thyroid function tests can be obtained, which usually show high FT4/FT3 and low TSH.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗07Does a patient need extremely high thyroid hormone levels to develop thyroid storm?
No. A very high hormone level is not required, and the degree of elevation is not directly tied to the risk of storm. One theory points to how fast levels rise rather than the absolute level.
VERIFIED AGAINST THE SOURCE
“One theory suggests the incidence of thyroid storm is due to the rapid increase in thyroid hormone levels rather than the absolute hormone level”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗08Does thyroid storm usually arise on its own, or does something set it off?
Something sets it off. A precipitating factor is always required, superimposed on diagnosed or undiagnosed hyperthyroidism.
VERIFIED AGAINST THE SOURCE
“Superimposed precipitating factors cause thyroid storms in patients with diagnosed or undiagnosed hyperthyroidism.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗09Which underlying thyroid disease most often leads to thyroid storm, and what other causes can?
Graves disease most often. It can also occur with other causes of hyperthyroidism, such as toxic multinodular goiter and toxic thyroid adenoma.
VERIFIED AGAINST THE SOURCE
“It is more common with Graves disease but can occur with other etiologies of hyperthyroidism, such as toxic multinodular goiter and toxic thyroid adenoma.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗10Why is abruptly stopping antithyroid medicine a recognized trigger of thyroid storm?
It is a listed precipitating factor. Stopping suddenly lets hormone levels climb quickly, and one theory holds that the rapid rise, not the absolute level, drives the storm.
VERIFIED AGAINST THE SOURCE
“One theory suggests the incidence of thyroid storm is due to the rapid increase in thyroid hormone levels rather than the absolute hormone level”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗11How can surgery and anesthesia lead to thyroid storm, and how is that risk lowered before thyroid surgery?
Thyroid surgery, non-thyroid surgery and the general anesthesia used for thyroid surgery can all trigger it. Taking antithyroid medicines before surgery helps prevent it.
VERIFIED AGAINST THE SOURCE
“Taking antithyroid medicines before surgery can help prevent this problem.”
— NIDDK (National Institutes of Health) ↗12Name acute illnesses that can precipitate thyroid storm.
Infections (including COVID-19), diabetic ketoacidosis, acute myocardial infarction, stroke, cardiac failure and drug reactions.
VERIFIED AGAINST THE SOURCE
“Acute illnesses like infections, including COVID-19, diabetic ketoacidosis, acute myocardial infarction, cardiovascular accident, cardiac failure, and drug reactions”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗13Besides surgery and acute illness, what other events are listed as thyroid storm triggers?
Trauma, childbirth (parturition), burns, stroke or traumatic brain injury, hyperemesis gravidarum in pregnancy, and, rarely, radioiodine therapy.
VERIFIED AGAINST THE SOURCE
“Hyperemesis gravidarum in pregnancy”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗14Why should a nurse note recent iodinated contrast in a patient with hyperthyroidism?
Recent iodinated contrast is a listed trigger of thyroid storm; the large iodine dose in contrast studies can set it off.
VERIFIED AGAINST THE SOURCE
“after administration of the large dose of iodine in contrast studies”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗15Which medications are named as possible triggers of thyroid storm?
Amiodarone, anesthetics and salicylates.
VERIFIED AGAINST THE SOURCE
“Medication side effects, eg, amiodarone, anesthetics, salicylates”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗16How common is thyroid storm among people hospitalized for hyperthyroidism?
It is rare: about 1 to 2 percent of admissions for hyperthyroidism.
VERIFIED AGAINST THE SOURCE
“Thyroid storm accounts for about 1% to 2% of admissions for hyperthyroidism.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗17What is the approximate male-to-female ratio and average age for thyroid storm?
About 1 male to 3 females, similar to thyrotoxicosis without storm, with an average age of 42 to 43 years.
VERIFIED AGAINST THE SOURCE
“The average age of people with thyroid storm was 42 to 43 years”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗18Why does thyroid storm strain the heart?
Intense metabolic activity raises oxygen demand. The tachycardia that results can bring on heart failure and arrhythmias.
VERIFIED AGAINST THE SOURCE
“The resulting tachycardia to meet the oxygen requirements can induce heart failure and predispose the patient to arrhythmias.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗19What role does the sympathetic nervous system play in thyroid storm?
During acute stress or infection, sympathetic hyperactivity, a heightened response to catecholamines and a stronger cellular response to thyroid hormone are proposed to drive the crisis.
VERIFIED AGAINST THE SOURCE
“The hyperactivity of the sympathetic nervous system with increased response to catecholamine and an increased cellular response to thyroid hormone during acute stress or infections”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗20Which body systems are commonly involved in thyroid storm?
Thermoregulation (fever), the cardiovascular system, the central nervous system and the gastrointestinal tract.
VERIFIED AGAINST THE SOURCE
“Fever, cardiovascular involvement (including tachycardia, heart failure, arrhythmia), central nervous system (CNS) manifestations, and gastrointestinal symptoms are common.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗21What fever range is a key presenting feature of thyroid storm, and what accompanies it?
A fever of 104 to 106 °F with heavy sweating (diaphoresis).
VERIFIED AGAINST THE SOURCE
“Fever of 104° F to 106°F with diaphoresis is a key presenting feature.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗22What cardiovascular findings can occur in thyroid storm?
Heart rate above 140 per minute, heart failure with pulmonary and peripheral edema, hypotension, arrhythmia, and death from cardiac arrest.
VERIFIED AGAINST THE SOURCE
“Cardiovascular manifestations include tachycardia of more than 140 HR/minute, heart failure with pulmonary and peripheral edema, hypotension, arrhythmia, and death from cardiac arrest.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗23What central nervous system changes can thyroid storm cause?
Agitation, anxiety, delirium, psychosis or coma.
VERIFIED AGAINST THE SOURCE
“CNS involvement includes agitation, delirium, anxiety, psychosis, or coma.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗24What gastrointestinal problems can thyroid storm cause?
Nausea, vomiting, diarrhea, abdominal pain, intestinal obstruction and acute liver failure.
VERIFIED AGAINST THE SOURCE
“Gastrointestinal (GI) symptoms include nausea, vomiting, diarrhea, abdominal pain, intestinal obstruction, and acute hepatic failure.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗25Besides thyroid tests, what other lab abnormalities may appear in thyroid storm?
High calcium, high blood glucose, abnormal liver function tests, and a white blood cell count that may be high or low.
VERIFIED AGAINST THE SOURCE
“Other lab abnormalities may include hypercalcemia, hyperglycemia (due to inhibition of insulin release and increased glycogenolysis), abnormal LFTs, and high or low white blood cell (WBC) count.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗26Why can blood glucose run high during thyroid storm?
Insulin release is inhibited and glycogen breakdown (glycogenolysis) increases.
VERIFIED AGAINST THE SOURCE
“hyperglycemia (due to inhibition of insulin release and increased glycogenolysis)”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗27What is the Burch-Wartofsky Point Scale?
A scoring system introduced in 1993 to support the diagnosis of thyroid storm. It adds points for temperature, CNS dysfunction, heart rate, heart failure, atrial fibrillation, GI or liver dysfunction, and a precipitating factor.
VERIFIED AGAINST THE SOURCE
“In 1993, the following scoring system for the diagnosis of thyroid storm was introduced”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗28How does temperature score on the Burch-Wartofsky Point Scale?
5 points for each 1 °F above 99 °F, up to a maximum of 30 points.
VERIFIED AGAINST THE SOURCE
“Temperature: 5 points per 1 F above 99 F (maximum 30 points)”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗29How is CNS dysfunction scored on the Burch-Wartofsky Point Scale?
10 points if mild (agitation), 20 if moderate (delirium, psychosis or extreme lethargy), 30 if severe (seizure or coma).
VERIFIED AGAINST THE SOURCE
“CNS dysfunction: 10 points for mild (agitation), 20 for moderate (delirium, psychosis, or extreme lethargy), and 30 for severe (seizure or coma)”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗30How are heart rate and atrial fibrillation scored on the Burch-Wartofsky Point Scale?
5 points for 99-109, 10 for 110-119, 15 for 120-129, 20 for 130-139, and 25 above 140. Atrial fibrillation adds 10 points.
VERIFIED AGAINST THE SOURCE
“Presence of atrial fibrillation:10”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗31How are heart failure, GI dysfunction and a precipitating factor scored on the Burch-Wartofsky Point Scale?
Heart failure: 5 mild (pedal edema), 10 moderate (bibasilar crackles), 15 severe (pulmonary edema). GI dysfunction: 10 moderate (diarrhea, nausea/vomiting or abdominal pain), 20 severe (unexplained jaundice). A precipitating factor adds 10.
VERIFIED AGAINST THE SOURCE
“Presence of Precipitating factor: 10 points”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗32How is a Burch-Wartofsky total score interpreted?
More than 45 is highly suggestive of thyroid storm, 25 to 44 supports the diagnosis, and less than 25 makes it unlikely.
VERIFIED AGAINST THE SOURCE
“Diagnosis: A score of more than 45 highly suggests thyroid storm, 25 to 44 supports the diagnosis, and less than 25 makes the diagnosis unlikely.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗33A patient with known hyperthyroidism and a urinary tract infection has a temperature of 103 °F, heart rate 135, and new delirium, with no heart failure, atrial fibrillation or GI signs. What is the Burch-Wartofsky score and what does it suggest?
70 points: temperature 20 (4 °F above 99 x 5), heart rate 20, moderate CNS dysfunction 20, precipitating factor 10. A score above 45 highly suggests thyroid storm.
VERIFIED AGAINST THE SOURCE
“Diagnosis: A score of more than 45 highly suggests thyroid storm, 25 to 44 supports the diagnosis, and less than 25 makes the diagnosis unlikely.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗34An alert patient with hyperthyroidism has a temperature of 100 °F and heart rate 105, with no other scored findings and no identified trigger. What is the Burch-Wartofsky score and what does it suggest?
10 points: temperature 5 (1 °F above 99) and heart rate 5. A score under 25 makes thyroid storm unlikely.
VERIFIED AGAINST THE SOURCE
“Diagnosis: A score of more than 45 highly suggests thyroid storm, 25 to 44 supports the diagnosis, and less than 25 makes the diagnosis unlikely.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗35Under the Japanese Thyroid Association criteria, what lab finding is a prerequisite, and what fever and heart-rate thresholds are used?
Thyrotoxicosis (elevated free T3 and/or free T4) is required. Fever is 38 °C (100.4 °F) or greater, and tachycardia is 130 per minute or higher.
VERIFIED AGAINST THE SOURCE
“Fever (38 C/100.4 F or greater) Tachycardia (130/min or higher)”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗36Which tests besides labs help in the workup of thyroid storm, and why?
An ECG to monitor for arrhythmias, a chest X-ray to assess heart failure, and in some patients a head CT to rule out a neurological cause.
VERIFIED AGAINST THE SOURCE
“A chest X-ray may help assess heart failure, and a head CT may help exclude a neurological cause in some patients.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗37Where should a patient with thyroid storm be cared for, and with what monitoring?
In the intensive care unit, with close cardiac monitoring and ventilatory support if needed. MedlinePlus likewise says patients need hospital treatment.
VERIFIED AGAINST THE SOURCE
“People need to be treated in the hospital.”
— MedlinePlus Medical Encyclopedia (National Library of Medicine, NIH) ↗38What supportive measures are part of thyroid storm treatment?
IV fluids, oxygen, cooling blankets and acetaminophen, alongside specific treatment of the hyperthyroidism.
VERIFIED AGAINST THE SOURCE
“Treatment of thyroid storm consists of supportive measures like intravenous (IV) fluids, oxygen, cooling blankets, acetaminophen, and specific measures to treat hyperthyroidism.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗39Why is acetaminophen, not aspirin, the fever reducer used in thyroid storm?
Aspirin should be avoided because it can raise free thyroid hormone levels by interfering with thyroid-binding protein. Acetaminophen is one of the listed supportive measures.
VERIFIED AGAINST THE SOURCE
“supportive measures like intravenous (IV) fluids, oxygen, cooling blankets, acetaminophen”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗40In thyroid storm, which drug class controls the increased adrenergic tone?
A beta-blocker.
VERIFIED AGAINST THE SOURCE
“Therapy to control increased adrenergic tone: Beta-blocker”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗41In thyroid storm, which drug class reduces new thyroid hormone synthesis?
A thionamide (propylthiouracil or methimazole).
VERIFIED AGAINST THE SOURCE
“Therapy to reduce thyroid hormone synthesis: Thionamide”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗42In thyroid storm, what therapy reduces the release of stored thyroid hormone?
An iodine solution.
VERIFIED AGAINST THE SOURCE
“Therapy to reduce the release of thyroid hormone: Iodine solution”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗43Which therapies block the peripheral conversion of T4 to T3 in thyroid storm?
Iodinated radiocontrast agents, glucocorticoids, propylthiouracil and propranolol.
VERIFIED AGAINST THE SOURCE
“Therapy to block peripheral conversion of T4 to T3: Iodinated radiocontrast agent, glucocorticoid, PTU, propranolol”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗44Which drug class reduces enterohepatic recycling of thyroid hormone?
A bile acid sequestrant, such as oral cholestyramine, which can be started in severe cases if available.
VERIFIED AGAINST THE SOURCE
“Oral cholestyramine 4 grams 4 times daily can be started for severe cases if available.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗45After initial supportive measures, which drug should be started for any suspected thyroid storm, and what is a typical regimen?
A beta-blocker. Typically propranolol 40 to 80 mg every 4 to 6 hours.
VERIFIED AGAINST THE SOURCE
“Typically, propranolol 40 mg to 80 mg is given every 4 to 6 hours.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗46What thionamide doses are used in thyroid storm?
Propylthiouracil 500 to 1000 mg loading dose, then 250 mg every 4 hours; or methimazole 20 mg every 4 to 6 hours.
VERIFIED AGAINST THE SOURCE
“Then, a loading dose of propylthiouracil (PTU) 500 mg to 1000 mg followed by 250 mg every 4 hours or Methimazole (MMI) 20 mg every 4 to 6 hours should be given.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗47Why is propylthiouracil favored over methimazole during the acute storm?
It also blocks some peripheral conversion of T4 to T3. In the first 24 hours it lowers T3 by about 45 percent, versus 10 to 15 percent with methimazole.
VERIFIED AGAINST THE SOURCE
“In the first 24 hours of treatment, propylthiouracil decreases the T3 level by 45%, but methimazole drops the T3 level by only 10 % to 15%.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗48Which must be given first in thyroid storm: the thionamide or the iodine solution, and why?
The thionamide, always before the iodine solution. Giving it first prevents the iodine load from fueling a surge in new thyroid hormone synthesis.
VERIFIED AGAINST THE SOURCE
“This prevents the imminent increase in thyroid hormone synthesis due to increased iodine load from super saturated potassium iodide.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗49When and how is SSKI given in thyroid storm?
About one hour after the propylthiouracil or methimazole: 5 drops by mouth every 6 hours.
VERIFIED AGAINST THE SOURCE
“An hour after administering propylthiouracil or methimazole, give 5 drops of SSKI (supersaturated potassium iodide) by mouth every 6 hours.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗50Which glucocorticoid regimens are started in thyroid storm?
Hydrocortisone 100 mg IV every 8 hours, or dexamethasone 2 mg every 6 hours.
VERIFIED AGAINST THE SOURCE
“Hydrocortisone 100 mg IV every 8 hours (or dexamethasone 2 mg every 6 hours) should also be started.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗51Why is methimazole often preferred over propylthiouracil once the acute phase passes?
After a few weeks of treatment, methimazole normalizes serum T3 more rapidly and causes less liver toxicity than propylthiouracil.
VERIFIED AGAINST THE SOURCE
“Methimazole causes more rapid normalization of serum T3 levels after a few weeks of treatment, and it has less hepatotoxicity compared to propylthiouracil.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗52How can antithyroid medicine be given to a patient in thyroid storm who cannot take it by mouth?
As a liquid preparation given by enema; the pharmacist may need to compound it.
VERIFIED AGAINST THE SOURCE
“For patients who cannot take oral antithyroid medicine, liquid preparation (pharmacist may have to compound) can be given as enemas.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗53Which beta-blocker can be given in the ICU as a short-acting option in thyroid storm?
Esmolol, given with a loading dose of 250 to 500 mcg/kg.
VERIFIED AGAINST THE SOURCE
“Esmolol, a short-acting beta-blocker, can be given in an ICU setting at a loading dose of 250 mcg/kg to 500 mcg/kg”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗54Which beta-blockers are chosen for a thyroid storm patient with reactive airway disease, and what if beta-blockers are contraindicated?
Cardioselective agents such as atenolol or metoprolol. If beta-blockers are contraindicated, diltiazem is an alternative.
VERIFIED AGAINST THE SOURCE
“If there is a contraindication for using beta-blockers, diltiazem is an alternative.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗55What is the plan if a patient in thyroid storm is allergic to thionamides?
Thyroidectomy is needed after treatment with a beta-blocker, hydrocortisone, cholestyramine and iodine solution.
VERIFIED AGAINST THE SOURCE
“If thionamide therapy is contraindicated because of an allergic reaction, thyroidectomy is needed after treatment with a beta-blocker, hydrocortisone, cholestyramine, and iodine solution.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗56What is the last-resort therapy for thyroid storm when all other measures fail?
Plasmapheresis.
VERIFIED AGAINST THE SOURCE
“Plasmapheresis is the last resort if all other measures fail.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗57Once a patient's condition improves after thyroid storm, how are the acute drugs adjusted?
The iodine solution is stopped, glucocorticoids are tapered and stopped, and beta-blockers are adjusted.
VERIFIED AGAINST THE SOURCE
“Once patients’ clinical conditions improve, the iodine solution should be stopped, glucocorticoids can be tapered and stopped, and beta-blockers should be adjusted.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗58What definitive treatment is recommended after recovery from thyroid storm, and what preparation does surgery need?
Radioiodine therapy or thyroidectomy. Surgical patients are pretreated with beta-blockers, glucocorticoids and iodine, and surgery is usually done after 5 to 7 days.
VERIFIED AGAINST THE SOURCE
“Surgery is usually done after 5 to 7 days.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗59Why can thyroid storm be misdiagnosed, and which conditions can mimic it?
Fever is common to many conditions. Mimics include sepsis or other infection, psychosis, cocaine use, pheochromocytoma, neuroleptic malignant syndrome and hyperthermia.
VERIFIED AGAINST THE SOURCE
“Sepsis Infection Psychosis Cocaine use Pheochromocytoma Neuroleptic malignant syndrome Hyperthermia”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗60Why do patients taking antithyroid drugs need CBC monitoring, and what finding stops the drug?
These drugs can lower the white cell count. A falling white cell count means the drug should be stopped because of the increased risk of infection.
VERIFIED AGAINST THE SOURCE
“If the white cell count starts decreasing, these drugs should be discontinued due to the increased risk of infection.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗61Which antithyroid medicine side effect should a patient report to the doctor right away?
Yellowing of the skin or the whites of the eyes (jaundice).
VERIFIED AGAINST THE SOURCE
“yellowing of your skin or whites of your eyes, called jaundice”
— NIDDK (National Institutes of Health) ↗62What are the usual causes of death in thyroid storm, and how fast do treated patients usually improve?
Heart failure, arrhythmias or multiple organ failure. With treatment, most patients improve within 24 hours.
VERIFIED AGAINST THE SOURCE
“However, with treatment, most patients see an improvement within 24 hours.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗63Which factors point to a poorer prognosis in thyroid storm?
Advanced age, neurological deficits on admission, failure to use beta-blockers and antithyroid medicines, and the need for dialysis or mechanical ventilation.
VERIFIED AGAINST THE SOURCE
“Need for dialysis and/or mechanical ventilation”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗64Which complications can follow untreated thyroid storm?
High-output cardiac failure, seizures, delirium and coma, among others.
VERIFIED AGAINST THE SOURCE
“High-output cardiac failure Seizures, delirium, coma”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗65What should patients with hyperthyroidism be taught about thyroid storm?
The warning symptoms of thyroid storm, a serious but rare emergency, and not to delay going to the emergency department if they appear. After a first crisis, missed medicines and other non-adherence should be addressed.
VERIFIED AGAINST THE SOURCE
“After the first crisis, non-compliant behaviors should be addressed”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗66What should the nurse do when a patient being treated for thyroid storm has a change in hemodynamic status?
Notify the physician. Nurses must know the potential complications and report any change in hemodynamic status.
VERIFIED AGAINST THE SOURCE
“Nurses must be fully aware of the potential complications and notify the physician if there is any change in the hemodynamic status.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗67Besides controlling the thyroid hormone excess, what else must the care team look for in thyroid storm?
The precipitating factor, such as an infection, which must be found and treated.
VERIFIED AGAINST THE SOURCE
“One should look for precipitating factors and treat them accordingly.”
— StatPearls, NCBI Bookshelf (National Library of Medicine, NIH) ↗68Which signs does MedlinePlus list for thyroid crisis, and where must patients be treated?
Fever, decreased alertness and abdominal pain; patients need to be treated in the hospital.
VERIFIED AGAINST THE SOURCE
“Fever, decreased alertness, and abdominal pain may occur. People need to be treated in the hospital.”
— MedlinePlus Medical Encyclopedia (National Library of Medicine, NIH) ↗69Which symptoms should prompt a person with hyperthyroidism to go to an emergency room or call 911?
A change in consciousness, dizziness, or a rapid, irregular heartbeat.
VERIFIED AGAINST THE SOURCE
“Go to an emergency room or call 911 or the local emergency number if you have: Change in consciousness Dizziness Rapid, irregular heartbeat”
— MedlinePlus Medical Encyclopedia (National Library of Medicine, NIH) ↗70What do beta-blockers do and not do for a patient with hyperthyroidism?
They ease symptoms such as tremor, fast heart rate, sweating, anxiety and nervousness until other treatments work, but they do not stop thyroid hormone production.
VERIFIED AGAINST THE SOURCE
“Medicines called beta-blockers may be prescribed to treat symptoms such as fast heart rate, tremor, sweating, and anxiety until the hyperthyroidism can be controlled.”
— MedlinePlus Medical Encyclopedia (National Library of Medicine, NIH) ↗71How do antithyroid medicines differ from beta-blockers in treating hyperthyroidism?
Antithyroid medicines (propylthiouracil or methimazole) reduce or block the effects of the extra thyroid hormone, while beta-blockers only control symptoms such as fast heart rate.
VERIFIED AGAINST THE SOURCE
“They don’t stop thyroid hormone production.”
— NIDDK (National Institutes of Health) ↗72Which everyday hyperthyroidism symptoms form the baseline that a thyroid storm builds on?
Weight loss despite increased appetite, a rapid or irregular heartbeat, and nervousness, irritability, trouble sleeping and fatigue, among others.
VERIFIED AGAINST THE SOURCE
“nervousness, irritability, trouble sleeping, fatigue”
— NIDDK (National Institutes of Health) ↗73Why can hyperthyroidism be missed in older adults?
It is sometimes mistaken for depression or dementia, and older adults may have different symptoms, such as loss of appetite or withdrawal from people.
VERIFIED AGAINST THE SOURCE
“Older adults may have different symptoms, such as loss of appetite or withdrawal from people, than younger adults with hyperthyroidism.”
— NIDDK (National Institutes of Health) ↗74Who is hyperthyroidism more common in?
Women and people older than 60.
VERIFIED AGAINST THE SOURCE
“Hyperthyroidism is more common in women and people older than 60.”
— NIDDK (National Institutes of Health) ↗75Why is propylthiouracil often chosen for hyperthyroidism in the first 3 months of pregnancy?
Because methimazole can, on rare occasions, harm the fetus.
VERIFIED AGAINST THE SOURCE
“Propylthiouracil is often used for women during the first 3 months of pregnancy because methimazole can, on rare occasions, harm the fetus.”
— NIDDK (National Institutes of Health) ↗76Which complications should the nurse watch for after thyroidectomy?
Hoarseness from recurrent laryngeal nerve damage, and low calcium from damage to the parathyroid glands (hypoparathyroidism).
VERIFIED AGAINST THE SOURCE
“Hoarseness due to nerve damage to the voice box Low calcium level due to damage to the parathyroid glands”
— MedlinePlus Medical Encyclopedia (National Library of Medicine, NIH) ↗77What long-term medicine does a patient need after thyroidectomy?
Lifelong thyroid hormone replacement (thyroxine).
VERIFIED AGAINST THE SOURCE
“you must take thyroid hormone replacement pills for the rest of your life”
— MedlinePlus Medical Encyclopedia (National Library of Medicine, NIH) ↗78A patient with Graves disease, a day after non-thyroid surgery, has a temperature of 104.5 °F, heavy sweating, heart rate 150 and new confusion. What is the first nursing action, and why?
Recognize possible thyroid storm and notify the provider at once, without waiting for lab results. Surgery is a trigger, the fever, heart rate and CNS change fit the picture, and the patient needs ICU care with cardiac monitoring and prompt supportive treatment.
VERIFIED AGAINST THE SOURCE
“Patients with thyroid storm must be admitted to the intensive care unit with close cardiac monitoring and ventilatory support if needed.”
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