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Thyrotoxic Crisis – Treatment and Management

Ivanina Arabadzhieva, Teodora Karamfilova, Kiril Hristozov, Evelina Zlatanova-Kazakova

Abstract

Introduction: Thyrotoxic crisis is a life-threatening complication of thyrotoxicosis. It might be caused by insufficient thyrostatic therapy or other diseases, mostly those with fever and inflammation, surgery and others.

Materials and Methods: Usually, evidence of prior hyperthyroidism or past surgery on the thyroid gland can be found in the medical history of the patient. The typical  symptoms include adynamia, tremors, hyperthermia, extreme tachycardia with frequent arrhythmias, hypotension, possibly vomiting and dehydration. Usually, the patients are with low BMI (body mass index) and severe muscle weakness. The symptoms leading to  thyroid pathology  are exophthalmos (or signs of thyroid - associated ophthalmopathy) and an enlarged thyroid. From a clinical point of view there are three stages of severity of the thyrotoxic crisis. They do not correlate with the serum levels of thyroid hormones but in all cases they are beyond the normal range.

Results: The total mortality rate of thyrotoxic crisis today is oscillating around 15-20%. Therefore, its occurrence must be prevented by early diagnosis of hyperthyroidism, proper treatment and avoiding the application of iodine-containing substances especially when hyperthyroidism is already present.

Conclusion: The diagnosis of thyrotoxic crisis is based mostly on clinical and not on hormonal evidence. It is a life-threatening situation. It is appropriate to test a serum for the study of TSH, FT4, but the treatment must begin even before the hormonal results. The treatment goals are to control the haemodynamic ,to correct the hyperpyrexia and neuro-psychic excitability and to block the hypersecretion of thyroid glands. It includes glucose-saline solutions, glucocorticoids, antithyroid, iodine medicine,  beta blockers, benzodiazepines and other symptomatic agents. All types of surgery must be performed after the function of the thyroid gland is normalized.


Keywords

thyrotoxic crisis, treatment


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