Dr. Robert McConnell | Morning Report | 01/11/2017
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
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
Created by Christopher Kelly
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