• Epidemiology of Thyroid Disease
  • Grave's disease typically presents in the 30's
  • Toxic Multinodular goiter is a more common cause of thyrotoxicosis in elderly patients
  • Marine-Lenhart Syndrome --> Overlap of toxic multinodular goiter and Grave's disease
  
  

  Posted 01/12/17 09:39:22 AM by Ying Liu

• Pathophysiology of Thyroid Storm
  • Bursch and Wartofsky Criteria for Thyroid Storm (1993) - more useful for research. Use clinical judgement
  • Usually precipitated by trigger such as sepsis and leads to unregulated thyroid hormone release --> both increased thyroid hormone from extra synthesis/release as well as conversion and displacement from thyroid binding globulin.
    • In sepsis along you have decreased peripheral conversion of T4 to T3 but in thyroid storm you'll have elevated T3 as well as T4
  • If thyroid binding hormone is low or is bound by meds such as aspirin, FT4 can be increased and cause symptoms
  • Thyroid hormones affect all organs but mortality general comes from its effects on the heart leading to arrythmias and high output heart failure
  
  
  
  

  Posted 01/12/17 09:43:16 AM by Ying Liu

• 5 Blocks of Treating Thyroid Storm
  1. Block thyroid hormone synthesis with thionamides
  • PTU is preferred over methimazole as it also prevents peripheral T4 to T3 conversion
  2. Block thyroid hormone release by giving Iodine
  3. Block T4 to T3 conversion with steroids
  • This can also help support the patient as many will have low adrenal reserve.
  4. Block enterohepatic circulation (10-30% of thyroid hormone metabolism occurs in the liver) with bile acid sequestration (cholestyramine)
  5. Block effects of thyroid hormones using beta blockade
  
  

  Posted 01/12/17 09:48:19 AM by Ying Liu

• Wolff-chaikoff Effect
  • Evolved from our past where iodide was rare and came in boluses
  • Excess iodide decreases thyroid hormone production, helping our body's deal with boluses and preventing thyrotoxicosis
  • Some people cannot recover from this and become clinically hypothyroid --> mechanism of amiodarone toxicity
  • Others don't have this compensation (patient's from iodine poor areas with large goiter) who can become toxic with an iodide load
  • A CT scan with contrast is a huge iodine load and can persist for weeks to months 
  
  

  Posted 01/12/17 09:51:10 AM by Ying Liu

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