Medical-Surgical Nursing

Post subtotal thyroidectomy BP is 150/100 Heart rate is 120 Temperature 40.

The nurse considered it cause

  1. A Hyper-metabolism due to increase in T3&T4 Correct answer
  2. B Hypo metabolism due to decrease T3&T4
  3. C Hypo metabolism due to increase in T3&T4
  4. D Hyper metabolism due to decrease in T3&T4

Explanation

Core Concept: Thyroid storm (thyrotoxic crisis) is a rare, life-threatening hypermetabolic state caused by a massive release of thyroid hormones (T3 and T4) into the bloodstream. It is often triggered by surgery (like thyroidectomy), infection, or trauma in patients with poorly controlled hyperthyroidism.

Clinical Presentation:

  • Severe tachycardia, hypertension, hyperthermia (fever up to 40°C/104°F), diaphoresis, agitation, and potential heart failure.

Diagnosis:

  • First-line plan: Clinical diagnosis based on the Burch-Wartofsky Point Scale (BWPS) assessing multi-system involvement.
  • Gold standard: Serum free T3 and free T4 (markedly elevated) with suppressed TSH, though treatment must not be delayed for lab results.

Management:

  • Acute: ABC support, aggressive cooling measures, beta-blockers (propranolol) to control heart rate, antithyroid drugs (PTU or methimazole) to block hormone synthesis, iodine solutions to block hormone release, and IV corticosteroids.
  • Long-term/Definitive: Once stabilized, definitive management of the underlying hyperthyroidism with radioactive iodine or completion thyroidectomy.

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