Thyrotoxic Crisis: Symptoms and Treatment
Thyrotoxic crisis is an acute condition that develops against the background of thyrotoxicosis in diffuse toxic goiter.There is a rare occurrence of a crisis, mainly in patients with severe disease or with treatment of goiter.Table of contents: Causes of the occurrence Symptoms of thyrotoxic crisis Diagnosis Treatment of thyrotoxic crisis
A thyrotoxic crisis occurs with a sharp increase in thyroid hormones: thyroxine and triiodothyronine.However, a similar high level of hormones is observed in the usual thyrotoxicosis.It turns out that this is not the only condition for the development of the crisis.
According to modern medical concepts, an important role in the development of the crisis is also played by adrenal insufficiency and increased activity of the sympathetic nervous system.
As a rule, the crisis develops after an operation to remove the gland or radioiodine therapy.Operative intervention, as well as treatment with radioactive iodine, should be carried out only after the medical achievement of the patient's state of euthyroidism, that is, the normal level of thyroid hormones in the blood.Failure to comply with these conditions can lead to a crisis.Much less often the thyrotoxic crisis develops simply against a background of severe diffuse toxic goiter.
There are certain factors that contribute to the development of the crisis:
- Infectious diseases;
- Psychoemotional stress;
- Any surgical interventions;
- Available medical conditions;
- Pregnancy and childbirth.
Symptoms of thyrotoxic crisis
The thyrotoxic crisis develops rapidly during the day, and sometimes for several hours.The earliest signs of a crisis are disorders from the nervous system.The person becomes restless, anxious, whiny, mood swings, insomnia.More severe disorders of the psyche can be observed up to psychoses or mental disorders.
Heart attack manifests itself in the form of arrhythmias, blockades, high blood pressure.The heart rate in a patient can reach two hundred beats per minute.Characteristic also increase in body temperature, sweating.
Often patients with a crisis complain of muscle weakness, which makes it difficult for them to do any movements.At the same time, a marked tremor of the extremities is noted.In addition, symptoms of a digestive tract are noted.Often there are diarrhea, nausea with vomiting, abdominal pain.
Important! A thyrotoxic crisis can be complicated by cardiac or renal insufficiency.These conditions are life threatening.
The diagnosis is based on the clinical picture of the pathological condition, as well as anamnesis( presence of diffuse toxic goiter, surgery on the gland).
The following studies can help in the diagnosis of thyrotoxic crisis:
- Determination of thyroid hormone levels( increased T3 and T4);
- Determination of thyroid-stimulating hormone( decrease in TSH level);
- Determination of cortisol level( cortisol decreased due to adrenal insufficiency);
- Carrying out electrocardiography( tachyarrhythmias, blockade are defined);
- Carrying out ultrasound of the thyroid gland( an auxiliary method that allows us to ascertain the presence of a goiter in a patient).
Treatment of thyrotoxic goiter
A thyrotoxic crisis is a real threat to a patient's life.Therefore, if symptoms of this pathological condition occur, it is necessary to deliver the patient to the hospital.
In the treatment of crisis, the doctor pursues the following objectives:
- Maintaining the body's basic functions;
- Inhibition of the synthesis and release of thyroid hormones;
- Reduces the effect of thyroid hormones on target organs;
- Detection and subsequent elimination of a provoking factor.
Maintenance of the basic functions of the body
As a result of excessive sweating, vomiting, diarrhea, the patient has a significant loss of fluid, which is fraught with dangerous consequences.To correct this condition, the patient is intravenously injected in a large volume of fluid and electrolytes.
Arrhythmia is treated with antiarrhythmic medications, and congestive heart failure with diuretics and cardiac glycosides.To combat progressive adrenal insufficiency, glucocorticosteroids are prescribed.
Inhibition of the synthesis and release of thyroid hormones
To suppress the synthesis of thyroid hormones, antithyroid drugs( Merkazolil, Tyrozol) are prescribed.Initially, a large dose of medication is prescribed, in the following days the dose is gradually reduced.The drug begins to act after an hour.However, the necessary therapeutic effect can be achieved only after a few days.
Slowing hormone release can be achieved by the introduction of iodine preparations.These drugs can be prescribed by a doctor in the form of drops for oral administration or in the form of intravenous infusions.
Reducing the effect of thyroid hormones on target organs
Beta-blockers( Propranolol) are used to eliminate rapid heartbeat, arrhythmia, anxiety, and psychoemotional agitation.The positive effect of using the drug is noted already after ten minutes after administration.To relieve psychoemotional arousal, tranquilizers are prescribed to the patient.
When treatment is not sufficient, resort to such methods as plasmapheresis, peritoneal dialysis.This method allows you to quickly clear the blood of thyroid hormones.
After the onset of active treatment, the patient's condition is improved after a few hours.However, in order to completely eliminate the crisis, it may take from two to eight days, which is associated with prolonged circulation of thyroxin in the blood.
Grigorova Valeria, medical reviewer