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Thyrotoxic crisis

Thyrotoxic crisis definition
The term encompasses clinical thyrotoxicosis, secondary to increased thyroid hormones, both exogenous and endogenous.

The thyroid storm is an exaggerated response of the body at an elevation of thyroid hormones.

The diagnosis is clinical and should be suspected in the presence of florid symptoms suggestive of hyperthyroidism, which translates into a metabolic and sympathetic hyperactivity: tachycardia, arrhythmias, nervousness, and restlessness, tremor, ventricular failure, diarrhea and hyperthermia.
Can lead to coma and death without treatment reaches 20 percent.

The Graves' disease is the most common cause of hyperthyroidism. The thyroid storm can occur in patients with any entity not controlled etiology of hyperthyroidism.
In practice, the triggers of thyroid storm are usually:
• and extrathyroidal thyroid surgery.
• Trauma.
• I-131 therapy.
• Infections.
• Emotional stress.
• Delivery.
Initial Diagnosis
First you have to suspect the clinical and pathological potential triggers it.

Presumptive diagnosis:
• We suspect a thyroid storm before the intensification of the symptoms of hyperthyroidism, being able to observe: nervousness, fine tremor, hot hands, excessive sweating, fever or hyperthermia (presence of fever in a patient diagnosed with hyperthyroidism without focus of infection should make us think of initiation of thyroid storm, and this is a warning sign), vomiting and / or diarrhea, decreased level of consciousness, tachyarrhythmias, palpitations, myocardial ischaemia. If the crisis progresses and does not appear aggressively treated with arterial hypotension, delirium and coma.
• Physical examination revealed the presence of goiter, exophthalmos, edema and eyelid retraction may be indicative of the presence of hyperthyroidism.
• are usually triggers a storm thyrotoxic previous trauma, surgery, thyroid scans and massage and treatment of hyperthyroid patients with radioactive iodine (due to the destruction of the thyroid to release its contents, occurs 10 to 14 days after administration of same), diabetic ketoacidosis, iatrogenic thyroid crisis.

Diagnosis confirmation:
• We should wait for laboratory confirmation to begin treatment. When in doubt of an overactive thyroid storm thyroid, blood samples to confirm the diagnosis later. Find: very high levels of T4 and TSH levels decreased.
• Must be done quickly the history and physical examination assessing the level of consciousness, hemodynamic and electrocardiographic monitoring, peripheral venous take.
• Confirmed the diagnosis of pathology is highly complex.

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