thyroid crisis

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(thyroid storm) a life-threatening condition due to a severe worsening of previously undiagnosed or inadequately treated thyrotoxicosis. It often follows infections, childbirth, nonthyroid surgery, or trauma but can occur without an obvious cause. The presenting features are a fever, severe agitation, nausea and vomiting, diarrhoea, and abdominal pains. An accelerated heart rate and irregularity of the heart rhythm can cause heart failure, and psychotic episodes or coma can result. Blood tests will reveal hyperthyroidism and may also show altered liver function, high blood sugar, high calcium levels, a high white blood cell count, and often anaemia. Treatment is with intravenous fluids, oxygen, antithyroid drugs (such as carbimazole or propylthiouracil), high-dose iodide solution (see Lugol’s iodine), high-dose steroids, and beta blockers. The patient must be cooled and given antipyretics, such as paracetamol. Any underlying cause must also be treated.

Subjects: Medicine and Health.

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