Thyrotoxic crisis - Causes, Symptoms and Treatment .MF .
thyrotoxic crisis - a severe, life-threatening condition of the patient, which is a complication of thyrotoxicosis, growing in diffuse toxic goiter (Graves' disease).The development of thyrotoxic crisis can lead to death.Fortunately, thyrotoxic crisis is not common.On average, according to different authors, in a certain percentage of cases.It may develop in severe Graves' disease.Graves' disease or diffuse toxic goiter - a disease of the thyroid gland, which is accompanied by the release into the bloodstream of excess amounts of thyroid hormones T 3 and T 4. tireotoksicheskom Stroke is a sharp increase in the production of thyroid hormones, is much higher than the norm, ie asevere thyrotoxicosis, which determines the severity and danger of this condition.
Symptoms of hyperthyroidism
reasons thyrotoxic crisis
As mentioned above, thyrotoxic crisis - a complication of diffuse toxic goiter.The cause thyrotoxic crisis is the lack of treatment or improper treatment of severe hyperthyroidism.
main cause thyrotoxic crisis is to perform operations related to the thyroid gland (complete or partial removal of the thyroid gland), as well as of treatment with radioactive iodine in patients with hyperthyroidism without achieving a normal hormonal status.
Before surgical treatment, as well as before treatment with radioactive iodine in patients with hyperthyroidism need training: you must first reach the so-called euthyroid state - a condition in which the thyroid hormones (T3 and T4) are in the normal range.This is achieved by assigning special preparations - thyreostatics that block the synthesis of an excess amount of hormones.
There are also factors that can contribute to thyrotoxic crisis, such as: stress, intense physical activity, any surgery, a variety of infectious diseases, exacerbation of chronic diseases, pregnancy, childbirth.All these factors, in the case of the presence of patients with severe thyrotoxicosis without adequate treatment, may trigger the development of thyrotoxic crisis.
symptoms of thyrotoxic crisis
patient is conscious.In the early development of the crisis the patient very nervous, fidgety, aggressive, may develop psychosis, further, on the contrary, the state of an excited expression can be replaced by apathy, lack, severe weakness.Maybe intense headache.
sign of thyrotoxic coma is expressed feeling palpitations (heart rate increases to 200 beats per minute), the pulse frequent, spasmodic.Characterized by the development of arrhythmias.Increased blood pressure.Breathing frequent, superficial.There is substantial (profuse) sweating.The skin is hot, red.Body temperature may rise to 40-41 degrees Celsius.
Typical nausea, perhaps vomiting, abdominal pain, loose stools (diarrhea), jaundice may appear.In severe cases, loss of consciousness can occur, coma development.
symptoms of thyrotoxic crisis
manifestations related to the fact that an excess of thyroid hormone has a damaging effect on the cardiovascular system, nervous system and adrenal glands.
diagnosis thyrotoxic crisis.
Diagnosis is based on data available in patients with thyrotoxicosis, acute symptoms after stressful situations, surgical treatment.Taken into account the characteristic clinical thyrotoxic crisis, its acute onset.
Laboratory diagnosis of disease:
1. The increase of thyroid hormones T3 and T4 increase
2. Reduction of thyroid stimulating hormone (TSH)
3. The reduction of cortisol - a hormone of the adrenal glands (as a consequence of thyrotoxic crisis arises adrenal lesion with the development of adrenal insufficiency)
4. It may be an increase in blood glucose level
5. For typical thyrotoxicosis lowering cholesterol levels in blood.
necessary to perform ECG recorded tachycardia (increased heart rate), and various types of arrhythmias.Characterized by the development of atrial fibrillation (arrhythmia mertsitelnoy).These changes are associated with cardiotoxic effect of excess thyroid hormone, an increase of T4 and T3 in the blood has a damaging effect on the cardiovascular system.
On thyroid ultrasound: is determined by an increase in thyroid size, increasing blood flow in the prostate tissue.
Treatment thyrotoxic crisis
thyrotoxic crisis is very dangerous, serious, life-threatening condition.Treatment is carried out only in a hospital under intensive care unit.It should be more early treatment possible.If you suspect that the development of thyrotoxic crisis neobhodma emergency admission to hospital.Lack of timely treatment threatens the life of the patient.
Treatment involves administering thyreostatics (such as tyrosol, Merkazolil) that block the synthesis of thyroid hormones, drugs beta-blockers group, which reduce heart rate, feeling of heart, are used to treat arrhythmias.
also used glucocorticosteroid hormones which developed for the treatment of adrenal insufficiency.To reduce the symptoms of intoxication infusion apply large quantities of liquid electrolytes.
antihypertensive drugs (drugs that lower blood pressure) are used for high blood pressure numbers.
If the patient is agitated, in the case of psychosis, tranquilizers are used.
In case of high fever antipyretics are used, apply the cooling procedure (wipe alcohol solutions can be used for cooling ice packs).
thyrotoxic crisis - a serious, life-threatening condition.Neobhodma immediate hospitalization.Extremely dangerous and unacceptable self-treatment, which can lead to death of the patient.From adjuvant treatment in a hospital can be recommended to use a neurotropic vitamins (vitamins B drugs: Milgamma, Neyromultivit and others).
Complications thyrotoxic crisis
development of adrenal insufficiency, severe arrhythmias, heart failure progression, that the delayed treatment leads to patient's death.
Prevention thyrotoxic crisis
should be timely detection of symptoms of hyperthyroidism.If you are planning surgery on the thyroid gland (resection or extirpation of the thyroid gland) or planned treatment with radioactive iodine, necessary pre-treatment of hyperthyroidism with achieving normal levels of thyroid hormones.hyperthyroidism treatment is carried out tireostatikami (tyrosol, Merkazolil), which reduce the synthesis of thyroid hormones.Only after reaching euthyrosis performed surgical treatment or treatment with iodine radoaktivnym.
forecast thyrotoxic crisis
depends on how timely treatment is started.With timely adequate treatment favorable prognosis.If untreated, poor prognosis.
Question: Why before surgical treatment of thyroid medication I prescribe?
Answer: If the person who planned the operation on the thyroid gland, located in the state of hyperthyroidism, need prior medical treatment tireostatikami until euthyrosis.Only after that can do the surgery, to avoid thyrotoxic crisis.
Question: If there is a suspicion on the development of thyrotoxic crisis, is it possible to out-patient treatment?
Answer: No, the treatment is only possible in a hospital intensive care unit, as this is a serious life-threatening condition.
endocrinologist Artemyev Marina S.