Hyperthyroidism

Background

Precipitants

1. infc
2. surg
3. trauma
4. dka
5. hypoglycemia
6. palpation of gland
7. withdrawal of meds

DDX

Grave's Disease

1. exophthalmos, increased metabolism, pretib myxedema
2. ab stim tsh receptor
3. decreased tsh conc
4. increased radioactive iodine uptake RAI
5. tx first with propylthiouracil or methimazole, then either albation, surg or more meds. Meds I organfication of I2

Treatment

1. If no CHF, hydrate with D5NS
2. Prograffin 3 gms qd (stops conversion and release)
3. Propranolol 1-2 mg IV up to 0.1 mg/kg q 1- 2 h. or 40- 80 mg q6h. for conv & betablock. not if chf or brochospasm
4. Iodide 30 ggts KI/d in divided doses or 0.5- 1.0 gm KaI in 1L ns q 12h. or sski 5 ggts q 6h. (stops release from gland)
5. Dexamethasone 2mg q6 or hydrocortisone 100mg iv qh (stops conversion)
6. Dopamine if hypotensive

See Also

Thyroid Storm

Thyroid (General)

Source

6/06 MISTRY