- life threatening exacerbation of hyperthyroid state with 1 or more organ dysfunction
- may occur 6-24 hours post surgery
- HR >140/min
- nausea and vomiting
- IVF (glucose)
- cooling cares
- paracetamol (no NSAIDs or aspirin -> displaces thyroxine from proteins)
- propanolol increments (1mg IV) or esmolol boluses -> infusion (50-100mcg/kg/min)
- hydrocortisone 200mg IV QID (adrenal insufficiency + decreases T4 release and conversion)
- propylthiouracil (1g load PO -> 250mg QID to inhibit thyroid hormone release and decrease peripheral conversion from T4-T3)
- after blockade by propylthiouracil give sodium iodide or potassium iodide or Lugol’s iodine
References and Links
- Bello G, Ceaichisciuc I, Silva S, Antonelli M. The role of thyroid dysfunction in the critically ill: a review of the literature. Minerva Anestesiol. 2010 Nov;76(11):919-28. PMID: 20935602.
- Carroll R, Matfin G. Endocrine and metabolic emergencies: thyroid storm. Ther Adv Endocrinol Metab. 2010 Jun;1(3):139-45. PMC3475282.
- Muller C, Perrin P, Faller B, Richter S, Chantrel F. Role of plasma exchange in the thyroid storm. Ther Apher Dial. 2011 Dec;15(6):522-31. PMID: 22107688.
FOAM and web resources
- ALIEM — Diagnosing hyperthyroidism: Answers to 7 common questions (2013)
- ALIEM — Thyroid Storm: Treatment Strategies (2013)
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.