Thyroid Storm

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Thyroid Storm
Introduction
In the emergency department, failure to recognize thyroid storm, also known as thyrotoxic crisis, can be lethal. Although the incidence of thyroid storm is relatively low, the mortality rate approaches 20% (Carroll & Matfin, 2010). It is theorized that causes of thyroid storm can be from a myriad of conditions: from myocardial infarction, to sepsis, and even Graves Disease. Although this diagnosis accompanies a high mortality rate, the treatment and management of this multi-organ process can be corrected. The astute provider can effectively diagnose, treat and refer this life-threatening condition.
Pathophysiology
The pathophysiology of thyroid storm is related to the checks and balance system of the thyroid. Under normal circumstances the hypothalamus releases Thyroid Releasing Hormone (TRH) which then triggers the pituitary gland to release Thyroid Stimulating Hormone (TSH). The TSH then triggers to thyroid to release T3 (triiodothyronine) and T4 (thyroxine). These hormones are made by the thyroid from dietary intake of iodine. T4 is the concentrated version of T3, and is changed into T3 in the body. T3 and T4 are then used by the body to regulate metabolism. If the levels of T3 and T4 are too high, the hypothalamus will then stop the production of TRH, thus stopping the cascade of the thyroid hormone. In the process of thyroid storm however, the checks and balance system has gone askew. The production of T3 and T4, although high, is not responding to the decrease in TRH. The continued production of T3 and T4 causes these levels to skyrocket, thus creating a state of hyper-metabolism (Carroll & Matfin, 2010). Patients with mildly elevated T3/T4 levels may be diagnosed with hyper...

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Metabolism Clinic of North America, 35, 663-686).
Ross, D. (2013, January 11). Thyroid storm. Retrieved November 23, 2013, from http://www.uptodate.com/contents/thyroid-storm Schaider, J. (2007). Rosen & Barkin's 5-minute emergency medicine consult. Philadelphia, PA:
Wolters Kluwer Health/Lippincott, Williams & Wilkins.
U.S. Department of Health & Human Services (USDHHS) (2013, October 28). Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Retrieved November 23, 2013, from http://www.guideline.gov/content.aspx?id=36623

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