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A thyroid crisis is a rare but life-threatening complication of hyperthyroidism. Therefore, people suffering from an overactive thyroid gland should visit an endocrinologist regularly, perform the prescribed tests and take medications as prescribed.
Definition of a thyroid crisis
A thyroid crisis is a sudden and life-threatening condition, it is a complication of an overactive thyroid gland. The ailment occurs in patients who have untreated hyperthyroidism, in addition, they are in a poor general condition and are struggling with infection. Nowadays, we rarely meet patients with a thyroid crisis, thanks to well-educated doctors and access to thyrostatic drugs.
The clinical picture of thyroid crisis is quite characteristic. There is a high fever, even 38-40 degrees C (less frequently subfebrile), significant tachycardia, confluent sweating, disorientation, periods of excitement and sometimes confusion, which end in coma.
The causes of a thyroid crisis
A thyroid crisis is caused by the body’s intolerance to excess thyroid hormones, which mainly affect the central nervous system. The main factor leading to the disease is thyrotoxicosis. Another name for a thyroid crisis is a thyroid storm. The disease can also be caused by Graves’ disease, complicated by bacterial or viral infection, or exacerbated by physical or mental factors.
Among the other factors influencing the formation of a thyroid crisis are:
- emotional shock,
- abortion,
- birth,
- stress,
- neglect of an overactive thyroid gland,
- rapid examination of the thyroid gland,
- treatment with radiotherapy,
- iodine exposure,
- infection
- infection,
- injuries,
- operations,
- thyroid gland resection,
- Discontinuation of treatment with anti-thyroid preparations.
Two groups of thyroid crisis
We divide the thyroid crisis into two groups:
1. breakthrough due to surgery on the thyroid gland – results from poor preparation for the operation. A patient operated on before achieving a stable, constant level of thyroid hormones immediately after the surgery or 1-2 days later falls into a state of a breakthrough. Today, the thyroid crisis associated with surgery is much less with medication;
2. internal breakthrough – occurs in patients with thyrotoxicosis under the influence of aggravating factors, such as radiotherapy, discontinuation of treatment, pneumonia, childbirth or abortion. This type of thyroid crisis comes on suddenly.
Symptoms of a thyroid crisis
The symptoms of a thyroid crisis are divided into three periods, depending on the development of the disease:
– hyperthermia, tachycardia, dehydration, sweating, atrial fibrillation, hand tremor, restlessness;
– psychotic symptoms, orientation problems, confusion;
– drowsiness, coma.
Before a thyroid crisis occurs, the patient is usually agitated and anxious. Mental disorders occur at night, and during the day the patient is most likely to sleep. Blood tests, on the other hand, show an increased concentration of FT4 and a decreased concentration of TSH, and sometimes hypoglycaemia may occur.
Diagnosing a thyroid crisis is not difficult. The patient is usually restless and agitated, and his skin is moist and flushed. Increased heart rate also appears. Patients with thyroid crisis also have an obvious eye syndrome, with increased temperature and vomiting. Appearing diarrhea and vomiting often lead to dehydration of patients. In addition, it occurs:
- delirium;
- pulmonary oedema;
- circulatory failure;
- cranial nerve palsy;
- swallowing problems;
- speech problems;
- mental disorders;
- disorders of the cardiovascular system;
- nervous system disorders.
How to proceed in the event of a thyroid crisis?
Thyroid crisis is a life-threatening condition, with up to 50% of cases fatal. The patient should be transported to the hospital as soon as possible or consult an endocrinologist. Rapid response is very important because the complications of the crisis are atrial fibrillation and supraventricular tachycardia, which in turn lead to cardiovascular collapse. If you notice disturbing symptoms in a patient with hyperthyroidism, call an ambulance immediately. Before you get help, use cold compresses to lower your body temperature.
In the ambulance, the patient receives the first preparations to stop the synthesis of thyroid hormones. In hospital, doctors will transfuse plasma or whole blood, and in some patients, beta-blockers are given to stop the harmful effects of thyroid hormones on the heart.
Treatment of thyroid crisis
The diagnosis of thyroid crisis is made by a doctor who takes into account the overall clinical picture, but there are no clear tests that confirm the diagnosis.
To bind free thyroid hormones as quickly as possible, the patient is given plasma or whole blood. Drugs that inhibit the synthesis of thyroid hormones, beta-blockers, fluids to correct water and electrolyte disturbances, sedatives, anticoagulants, iodine in the form of potassium iodide or iodinated contrast agents are also administered. It is also important to cool the body with cold compresses. If necessary, the patient is also given oxygen, antibiotics and antipyretic drugs. Most drugs are administered intravenously.
After the most dangerous symptoms of thyroid crisis are under control, treatment is continued with oral anti-thyroid medications. The drug doses are usually the same as for full-blown thyrotoxicosis. The patient has to stay in bed for many days, and recovery is very slow.
After a full-blown thyroid crisis, patients recover very slowly. They are usually very weak and have symptoms of severe thyroid myopathy (muscle damage), which means that they have to stay in bed for many days.
IMPORTANT INFORMATION! A thyroid crisis can be confused with a pheochromocytoma of the adrenal medulla or a vegetative crisis. Symptoms similar to those in the thyroid crisis also occur in people who have taken psychoactive substances and are exposed to frequent stress. Also, patients who stay in high temperatures or are exposed to the sun on a daily basis have similar symptoms similar to a thyroid crisis.
Watch more at OnetVOD: Thyroid Disorders