Page 342 - Critical Care Nursing Demystified

Chapter 7 CARE OF THE PATIENT WITH ENDOCRINE DISORDERS 327

Thyroid Storm/Thyrotoxic Crisis

What Went Wrong?
Untreated or uncontrolled hyperthyroidism can precipitate a severe and rapidly
worsening condition of a hypermetabolic, overactive thyroid state. It is a life-
threatening and critical complication with an acute, sudden onset. Causes could
be infection, trauma, or surgery in patients with preexisting hyperthyroidism.
Emergency management must be provided quickly and aggressively.

Hallmark Signs and Symptoms
These include heart failure; severe tachycardia and tachypnea; intolerance to
heat; excessive diaphoresis; hot, flushed skin; extreme pyrexia with body tem-
peratures of 105.3°F; abdominal pain; nausea; vomiting; diarrhea; agitation; rest-
lessness; seizures; delirium; and coma. Immediate therapy includes fever reduction
with cooling blankets and acetaminophen. Assess body temperatures q 15 minutes
until temperatures reach a safe level; institute appropriate intravenous fluid
replacement to counter the effects of hyperthermia and fluid losses from vomit-
ing and diarrhea. Reduce circulating thyroid hormone levels with the appropriate
drug therapy. Verapamil, a calcium channel blocker, is effective in controlling
tachycardia and esmolol, a short-acting beta-blocker used for short-term, rapid Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
control of atrial fibrillation, are medications that might be ordered.

Prognosis
Current methods of diagnosing and treating hyperthyroidism have significantly
reduced the incidence of Thyroid Storm, making it relatively uncommon.
5 Interpreting Test Results
Specific laboratory tests are completed to diagnose and monitor progression of
thyroid disease. As nurses, it is important to remember that certain medications can
interfere with thyroid test results, such as heparin, dopamine, and corticosteroids.
The free thyroxine test (free T4) and TSH (released by the anterior pituitary
gland) are the two main laboratory tests recommended for testing by the Amer-
ican Thyroid Association.

NURSING ALERT

The following three points should be emphasized: (1) High doses of corticosteroids
and dopamine infusions can suppress TSH levels. (2) Thyroid hormones increase cho-
lesterol metabolism. Therefore, people with hyperthyroidism tend to have low serum
cholesterol levels, while those with hypothyroidism tend to have high serum choles-
terol levels. (3) Test results can be inconclusive in the critically ill patient as the stress
of illness interferes with normal hormonal production and regulation.