Hyperthyroidism

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Background

Precipitants:

-infc

-surg

-trauma

-dka

-hypoglycemia

-palpation of gland

-withdrawal of meds


DDX

Grave's Disease

- exophthalmos, increased metabolism, pretib myxedema

- ab stim tsh receptor

- decreased tsh conc

- increased radioactive iodine uptake RAI

- tx first with propylthiouracil or methimazole, then either albation, surg or more meds. Meds I organfication of I2


Treatment

1) If no CHF, hydrate with D5NS

2) Prograffin 3 gms qd (stops conversion and release)

3) Propranolol 1-2 mg IV up to 0.1 mg/kg q 1- 2 h. or 40- 80 mg q6h. for conv & betablock. not if chf or brochospasm

4) Iodide 30 ggts KI/d in divided doses or 0.5- 1.0 gm KaI in 1L ns q 12h. or sski 5 ggts q 6h. (stops release from gland)

5) Dexamethasone 2mg q6 or hydrocortisone 100mg iv qh (stops conversion)

6) Dopamine if hypotensive


See Also

Endo: Thyroid Storm

Endo: Thyroid (General)


Source

6/06 MISTRY