Thyrotoxic crisis can take the life of your patient!

Thyrotoxic crisis – this is a fairly rare, but very serious pathological condition, & nbsp; acutely occurring in patients with such pathology of the thyroid gland as diffuse goiter, characterized by a sharp & nbsp; an increase in the severity of symptoms of thyrotoxicosis. The danger of a thyrotoxic crisis lies in the fact that a progressive deterioration in the patient's condition develops very quickly, with a high probability of developing cardiac, adrenal or liver failure and death. Thyrotoxic crisis requires immediate onset & nbsp; a complex of therapeutic measures. 

Main causes of thyrotoxic crisis

Unfortunately, there are no clear prognostic criteria for the occurrence of a thyrotoxic crisis. Increased symptoms of thyrotoxicosis most often occurs after strumectomy – operations to remove the thyroid gland, as a hormonal response of the organ to surgical manipulations. The second most common cause of a thyrotoxic crisis is the use of radioactive iodine for therapeutic purposes.  Much less often, a thyrotoxic crisis can be provoked by such factors:

• trauma or surgery on other organs;
• infectious process;
• intravenous administration of iodine for the purpose of contrasting in X-ray examination;
• a course of radiotherapy;
• gross trauma to the thyroid gland;
• sudden cessation of thyrostatic therapy;
• A state of hypoglycemia and diabetic ketoacidosis.

Thyrotoxic crisis is manifested by increased symptoms of thyrotoxicosis

During a thyrotoxic crisis, two phases are distinguished: subacute and acute or comatose. The first phase takes a time interval from the onset of the first symptoms of thyrotoxicosis to the development of a coma. The second phase develops within 12-48 hours from the onset of the subacute phase. The course of the thyrotoxic crisis is fulminant – the patient's condition worsens in a matter of seconds, so it is necessary to constantly monitor his vital functions. Early signs of a thyrotoxic crisis are & nbsp; an increase in body temperature and increased sweating, and already at this stage of clinical manifestations, the doctor should suspect the development of a thyrotoxic crisis. Subsequently, other organs and systems are involved in the pathological process: the thyroid gland increases, exophthalmos may appear, & nbsp; abdominal pain, hepatomegaly and jaundice develop. Damage to the central nervous system is characteristic in the form of signs of developing toxic encephalopathy, up to the development of coma, signs of heart failure appear: systolic hypertension turns into hypotension with collapse.

Diagnostic signs of thyrotoxic crisis

In addition to the objective signs of the development of a thyrotoxic crisis, this condition is confirmed by the results of laboratory tests. But it must be remembered that if symptoms of increasing thyrotoxicosis occur, it is necessary to immediately begin therapeutic measures, and only in parallel with this can the condition be diagnosed. Thyrotoxic crisis confirms, first of all, significantly increased concentrations of the hormones T3 and T4 in the blood.  In the general blood test, changes characteristic of thyrotoxicosis will not be determined. & nbsp; According to the results of a biochemical blood test, hypocholesterolemia, hypoproteinemia, a decrease in the prothrombin index and fibrinogen, as well as an increase in the activity of ALT and AST can indicate an increase in the symptoms of thyrotoxicosis. 

Emergency care in the event of a thyroid crisis

When  the first signs of the development of a thyrotoxic crisis appear, the patient is urgently hospitalized in the intensive care unit and emergency therapy is started. It is necessary to reduce high concentrations of thyroid hormones. To reduce their synthesis by the thyroid gland, antithyroid drugs are administered: thiamazole and propylthiouracil. Only after the start of the introduction of antithyroid drugs, it is possible to connect drugs that prevent the conversion of T3 to T4 – inorganic iodine or lithium carbonate.  Carrying out dialysis or plasmapheresis contributes to a rapid decrease in the concentration of thyroid hormones in the blood. Beta-blockers, glucocorticoids, antipyretics, diuretics or electrolyte solutions are also used to reduce the symptoms of thyrotoxicosis – depending on the course of the thyrotoxic crisis in each specific case. It must be remembered that all dosages of drugs are calculated strictly individually for each patient. Constant monitoring and effective measures to compensate for the manifestations of thyrotoxicosis will help protect the patient from the development of such a life-threatening pathological condition of the thyroid gland as thyrotoxic crisis.