Endocrinology : Thyrotoxic crisis

Thyrotoxic crisis :

Thyroid storm, also referred to as thyrotoxic crisis, is an acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones (THs) in individuals with thyrotoxicosis.

Clinical features of thyrotoxic crisis / Storm:

Weight loss

Heat intolerance

Sweating

Palpitations

Tremor

Diarrhoea

Anxiety

Agitation

Irritability

Precipitating causes of Thyrotoxic crisis:

Withdrawal of Antithyroid drug therapy

Infection

Radio iodine treatment

Iodinated contrast dyes

Thyroid surgery

Child birth

Clinical Examination :

Following features would be observed :

General :

Agitation

Anxiety

Restlessness

Tremor

Warm skin and moist

Hyperpyrexia

Cardiovascular compromise :

Sinus Tachycardia : Hewart beat greater than 140 bpm in thyroid crisis.

Fast Atrial fibrillation or supraventricular tachy cardia is also common.

Neurological features :

Altered consciousness

Frank psychosis

Delirium

Seizures and

Coma may be present.

Findings suggestive of Thyroid pathology include the following :

Signs of Graves disease :

Exophthalmos

Lid retraction

Lid Lag

Goitre :

Smooth Vs nodular

Any associated bruit

Vitiligo associated with Auto immune Thyroid disease.