Thyroid crisis, also known as thyrotoxic crisis, is characterized clinically by increased signs and symptoms of hyperthyroidism and associated with dysfunctional changes in multiple organs and systems. Thyroid crisis is a rare endocrine complication. Most thyroid crises are preceded by predisposing factors, most commonly inappropriate discontinuation of ATD and infections (especially upper respiratory infections). 131 iodine therapy rarely triggers thyroid crises. Early diagnosis and treatment of thyroid crisis is important to reduce the death rate and improve the prognosis of patients.
I. Clinical manifestations.
1. Typical hyperthyroid crisis.
(1) Hyperthermia: rapid increase in body temperature, often above 39℃, profuse sweating and flushed skin.
(2) Cardiovascular system: The pulse pressure difference increases significantly, and the heart rate increases significantly, exceeding 160 beats/min. Patients are prone to various rapid arrhythmias, such as precontraction, atrial tachycardia, paroxysmal and persistent atrial fibrillation, with precontraction and atrial fibrillation being the most common.
(3) Digestive system: Very poor appetite, frequent nausea and vomiting, abdominal pain and diarrhea are obvious. Some elderly patients have digestive symptoms as the prominent manifestation.
(4) Central nervous system: psychoneurological disorders, anxiety, irritability, drowsiness, and finally coma.
(2) Pre-critical signs.
Because of the high mortality rate during the critical phase, often dying from shock and heart failure, the diagnosis of pre-critical or aura-critical is clinically proposed for timely rescue of patients. Pre-critical signs are.
(1) body temperature between 38℃ and 39℃.
(2) Heart rate between 120 and 159 beats/min, which may also have arrhythmia.
(3) Loss of appetite, nausea, increased frequency of stools, excessive sweating.
(4) Anxiety, restlessness, and a sense of crisis.
3. Atypical hyperthyroidism crisis.
Patients with atypical hyperthyroidism or pre-existing systemic failure or hyperemesis gravidarum. The typical manifestations mentioned above are often absent at the onset of the crisis, and only one of the following systemic manifestations may be present, for example
(1) Cardiovascular system: severe arrhythmias such as atrial fibrillation or heart failure.
(2) Digestive system: nausea, vomiting, diarrhea, jaundice.
(3) Psychoneurological system: psychosis or apathy, xylopathy, extreme weakness, drowsiness unresponsiveness. Coma, hyporesponsiveness.
(4) Hypothermia, dry skin without sweating.
II. Diagnosis.
Diagnosis of thyroid crisis is based mainly on clinical manifestations rather than thyroid hormone levels.
III. Treatment.
In the treatment of thyroid crisis, each aspect of thyroid hormone production and action is the target of treatment, and a combination of treatments is usually required.
Treatment principles.
1. Rapid inhibition of thyroid hormone synthesis.
Propylthiouracil tablets 300 mg every 6 hours orally or intranasally are generally preferred. High-dose thioureas can block thyroxine synthesis within 1 hour.
2. Rapid inhibition of thyroid hormone release.
Usually take compound iodine solution orally 2 hours after taking antithyroid drugs.
3.Clearance of excess thyroid hormone in the blood.
When the effect of conventional treatment is unsatisfactory, measures such as peritoneal dialysis, hemodialysis or plasma exchange can be used to rapidly reduce plasma thyroid hormone concentration.
4. Reduce the response of surrounding tissues to thyroid hormone.
For example, take insulin orally or by intravenous drip.
5.Application of adrenal glucocorticoids.
Hydrocortisone or dexamethasone intravenously in divided doses.
6.Remove the cause, symptomatic and supportive treatment.
Such as cooling, ensuring caloric intake, maintaining blood volume and improving cardiac function.