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Thyrotoxic crisis
Last reviewed: 05.07.2025
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Thyrotoxic crisis is a life-threatening complication of untreated or improperly treated thyrotoxicosis, manifested by severe multi-organ dysfunction and high mortality.
Causes of Thyrotoxic Crisis
The role of provoking factors can be played by stressful situations, physical overexertion, acute infections, including in the neonatal period, intravenous administration of radiocontrast agents, cessation of antithyroid therapy, surgical interventions, primarily on the thyroid gland, tooth extraction.
[ Symptoms of Thyrotoxic Crisis
The development of thyrotoxic crisis in children is manifested by an increase in body temperature over 40 °C, severe headaches, delirium, hallucinations, general motor and mental anxiety, followed by adynamia, drowsiness and loss of consciousness. Gastrointestinal disorders are observed: diarrhea, nausea, vomiting, abdominal pain, jaundice of the skin.
Renal function is impaired, diuresis decreases to the point of anuria. Heart failure may develop. Sometimes - acute liver atrophy.
Criteria for the diagnosis of thyrotoxic crisis
The diagnosis is established based on the anamnesis data and relevant clinical manifestations. The condition must be differentiated primarily from pheochromocytoma, sepsis and hyperthermia of other genesis. Laboratory examination reveals an increased content of thyroid hormones in the blood serum, with a low level or absence of TSH. Changes in the general blood test (anemia, leukocytosis), biochemical blood test (hyperglycemia, azotemia, hypercalcemia, increased activity of liver enzymes) reflect the severity of developing organ disorders.
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Emergency medical care for thyrotoxic crisis
After access to the vein, it is necessary to administer water-soluble forms of hydrocortisone (Solu-Cortef) at a dose of 2 mg/kg per injection. The same amount of the drug is administered intravenously by drip in 0.9% sodium chloride solution and 5% glucose solution with the addition of 5% ascorbic acid solution (20 mg/kg) for 3-4 hours. Other glucocorticosteroids (prednisolone or dexamethasone) can be used. In some cases, it is necessary to administer mineralocorticoids intramuscularly: deoxycorticosterone acetate (deoxycortone) 10-15 mg/day under the control of blood pressure and diuresis on the first day, then the dose is reduced to 5 mg/day.
Infusion therapy is carried out with sodium-containing solutions depending on the degree of dehydration: at the rate of 50 ml/(kg x day) or 2000 ml/m2 - to compensate for physiological needs for fluid and 10% of the calculated volume - for rehydration, but not exceeding 2-3 liters until hemodynamic parameters stabilize and fluid intake is possible. In case of uncontrollable vomiting, a 10% sodium chloride solution can be used intravenously at the rate of 1 ml per year of life and metoclopramide at a dose of up to 0.5 mg/kg.
To reduce the reaction of the cardiovascular system, beta 2 -blockers are administered: 0.1% solution of inderal or propranolol (obzidan, anaprilin) is prescribed intravenously at a dose of 0.01-0.02 ml / kg, for adolescents a maximum of up to 0.15 mg / kg x day). The drugs can be used orally (atenolol), dosing based on changes in heart rate (no more than 100 per minute in adolescents) and blood pressure. When there are contraindications for the use of beta 2 -blockers (in bronchial asthma, shock, acute heart failure), a 25% solution of reserpine is prescribed 0.1 ml per year of life. The use of sedatives is indicated, preferably diazepam at a dose of 0.3 mg / kg. In case of an increase in body temperature, physical cooling methods are used. Oxygen therapy is carried out (50% O 2 ). Proteolytic enzyme inhibitors (aprotinin) are prescribed in a hospital setting.
If there is evidence of the development of cerebral edema in the case of coma, mannitol 1 g/kg in the form of a 10-15% solution, furosemide 1-3 mg/kg, and also a 25% solution of magnesium sulfate 0.2 ml/kg are administered intravenously.
To reduce endogenous synthesis of thyroid hormones, antithyroid drugs are prescribed - thiouracil derivatives (thiamazole or mercazolil 40-60 mg immediately, then 30 mg every 6 hours, if necessary - through a gastric tube) or methimazole analogues (favistan, tapazole at a dose of 100-200 mg / day). In severe cases, Lugol's solution is used intravenously by drip in the form of a 1% solution (50-150 drops of sodium iodide per 1 liter of 5% glucose solution). Subsequently, it is indicated to administer Lugol's solution orally 3-10 drops (up to 20-30 drops) 2-3 times a day with milk or through a thin gastric tube. A 10% sodium iodide solution is also used 5-10 ml in microclysters every 8 hours. If emergency measures are ineffective, hemosorption is performed.
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