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Thyrotoxic crisis
Last reviewed: 23.04.2024
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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 lethality.
Causes of thyrotoxic crisis
The role of provoking factors can play stressful situations, physical overstrain, acute infections, including during the period of the newborn, intravenous radiocontrast substances, discontinuation of thyrostatic therapy, surgical interventions, primarily on the thyroid gland, extraction of the tooth.
[Symptoms of thyrotoxic crisis
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, alternating adynamy, drowsiness and loss of consciousness. Observe abnormalities from the digestive tract: diarrhea, nausea, vomiting, abdominal pain, icterism of the skin.
There is a violation of kidney function, diuresis is reduced until anuria. Heart failure may develop. Sometimes - acute atrophy of the liver.
Criteria for the diagnosis of thyrotoxic crisis
The diagnosis is established based on the history and the corresponding clinical manifestations. The condition must be differentiated first of all with pheochromocytoma, sepsis and hyperthermia of another genesis. Laboratory examination reveals an elevated level of thyroid hormones in the serum, with a low or no TSH. Changes in the general blood test (anemia, leukocytosis), biochemical blood analysis (hyperglycemia, azotemia, hypercalcemia, increased activity of liver enzymes) reflect the severity of developing organ disorders.
What do need to examine?
How to examine?
Emergency medical care for thyrotoxic crisis
After access to the vein, it is necessary to introduce water-soluble forms of hydrocortisone (Solu-Kortef) at a dose of 2 mg / kg per injection. The same amount of the drug is injected intravenously in a 0.9% solution of sodium chloride and 5% glucose solution with the addition of 5% solution of ascorbic acid (20 mg / kg) for 3-4 hours. You can use other glucocorticosteroids (prednisolone or dexamethasone). In some cases, it is necessary to intramuscularly introduce mineralocorticoids: deoxycorticosterone acetate (deoxy cortone) 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: from the calculation of 50 ml / (kg x-ray) or 2000 ml / m 2 - to compensate physiological needs in the liquid and 10% of the calculated volume for rehydration, but not exceeding 2-3 liters to stabilization of hemodynamic parameters and the possibility of fluid intake. With indomitable vomiting, 10% sodium chloride solution can be applied intravenously, based on 1 ml per year of life and metoclopramide at a dose of up to 0.5 mg / kg.
To reduce the reaction from the cardiovascular system, beta- 2- adrenoceptors are administered : 0.1% solution of indral or propranolol (obzidan, anaprilin) is administered intravenously at a dose of 0.01-0.02 ml / kg, adolescents maximum - up to 0.15 mg / kgsut). Drugs can be used inside (atenolol), dosing by changing the heart rate (no more than 100 per minute in adolescents) and blood pressure. When there are contraindications for the use of beta- 2- adrenoblockers (for bronchial asthma, shock, acute heart failure), 25% reserpine solution is prescribed 0.1 ml per year of life. The use of sedatives, preferably diazepam in a dose of 0.3 mg / kg, is indicated. In case of an increase in body temperature, physical methods of cooling are used. Carry out oxygen therapy (50% O 2 ). Inhibitors of proteolytic enzymes (aprotinin) are prescribed in a hospital.
For data on the development of cerebral edema in the case of coma, 1 g / kg mannitol is administered intravenously in the form of 10-15% solution, furosemide 1-3 mg / kg, and 25% magnesium sulfate solution 0.2 ml / kg.
To reduce the endogenous synthesis of thyroid hormones, antithyroid drugs - thiouracil derivatives (thiamazole or mercazolil 40-60 mg immediately, then 30 mg every 6 hours, if necessary, through the stomach probe) or methylimazole analogues are prescribed (favistan, tapazal at a dose of 100-200 mg / day). In severe cases, Lugol's solution is dripped intravenously in the form of a 1% solution (50-150 drops of sodium iodide per 1 liter of 5% glucose solution). Subsequently, the introduction of Lugol's solution inside by 3-10 drops (up to 20-30 drops) 2-3 times a day with milk or through a thin gastric tube is shown. A 10% sodium iodide solution of 5-10 ml in microclyster every 8 hours is also applied. If the urgent measures are ineffective, hemosorption is carried out.