Medical-Surgical Nursing
Post subtotal thyroidectomy BP is 150/100 Heart rate is 120 Temperature 40.
The nurse considered it cause
الشرح
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.