Thyrotoxic crisis - Causes, symptoms and treatment. MF.

Thyrotoxic crisis is a serious, life threatening condition of the patient, which is a complication of thyrotoxicosis, which develops 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 several percent of cases. It can develop with a serious course of Graves disease. Graves' disease, or diffuse toxic goiter, is a disease of the thyroid gland, which is accompanied by the release into the blood of excess thyroid hormones: T 3 and T 4. With thyrotoxic crisis, there is a sharp increase in the production of thyroid hormones, many times higher than normal,severe thyrotoxicosis, which determines the severity and danger of this condition.

Symptoms of thyrotoxicosis

Causes of thyrotoxic crisis

As mentioned above, thyrotoxic crisis is a complication of diffuse toxic goiter. The cause of thyrotoxic crisis is the absence of treatment or improper treatment of severe thyrotoxicosis.

The main cause of thyrotoxic crisis is the performance of operations associated with the thyroid( complete or partial removal of the thyroid gland), as well as the conduct of treatment with radioactive iodine in patients with thyrotoxicosis without first reaching a normal hormonal status.

Before surgical treatment, as well as before treatment with radioactive iodine in patients with thyrotoxicosis, preparation is necessary: ​​the so-called euthyroid state - a condition in which thyroid hormones( T3 and T4) are within the normal range must be previously achieved. This is achieved by the appointment of special drugs - thyreostatics, which block the synthesis of excess hormones.

There are also factors that can contribute to the occurrence of thyrotoxic crisis, such as: stressful situations, intensive physical activity, any surgical treatment, various infectious diseases, exacerbation of severe chronic diseases, pregnancy, childbirth. All these factors, in the case of a patient with severe thyrotoxicosis without adequate treatment, can trigger the development of thyrotoxic crisis.

Symptoms of thyrotoxic crisis

The patient is conscious. At the beginning of the crisis, the patient is very nervous, fussy, aggressive, can develop psychosis, then, on the contrary, the state of pronounced excitement can be replaced by apathy, lack of mobility, severe weakness. May be an intense headache.

The symptom of thyrotoxic coma is a feeling of marked palpitation( heart rate increases to 200 beats per minute), the pulse is frequent, irregular. Characteristic is the development of arrhythmias. Increases blood pressure. Breathing is rapid, superficial. There is pronounced( profuse) sweating. Skin covers are hot, red. Body temperature can rise to 40-41 degrees Celsius.

Typical nausea, there may be vomiting, abdominal pain, loosening of the stool( diarrhea), jaundice may appear. In severe cases, loss of consciousness, coma development may occur.

Symptoms of thyrotoxic crisis

Manifestations are caused by the fact that excess thyroid hormones have a damaging effect on the cardiovascular system, the nervous system, the adrenal glands.

Diagnosis of thyrotoxic crisis.

The diagnosis is established on the basis of data on the patient's thyrotoxicosis, exacerbation of symptoms after stressful situations, surgical treatment. The characteristic clinic of the thyrotoxic crisis, its acute onset, is taken into account.

Laboratory diagnostics of the disease:

1. Increase in thyroid hormones: increase in T3 and T4
2. Reduction of thyroid stimulating hormone( TSH)
3. Reduction of cortisol - adrenal hormone( as a result of thyrotoxic crisis, adrenal damage occurs with adrenal insufficiency)
4.There may be an increase in the blood glucose level of
5. For thyrotoxicosis, a decrease in the level of cholesterol in the blood is characteristic.

An ECG is required: tachycardia( increased heart rate), various types of arrhythmias are recorded. Characteristic is the development of atrial fibrillation( a sensational arrhythmia).These changes are associated with the cardiotoxic effect of an excess of thyroid hormones, that is, an increase in T3 and T4 in the blood has a damaging effect on the cardiovascular system.

Ultrasound of the thyroid gland: an increase in the size of the thyroid gland, an increase in the rate of blood flow in the gland tissue is determined.

Treatment of thyrotoxic crisis

The thyrotoxic crisis is a very dangerous, serious, life-threatening condition. Treatment is carried out only in a hospital in the intensive care unit. It is necessary to start treatment as early as possible. If suspected to develop thyrotoxic crisis, emergency hospitalization in the hospital is necessary. Lack of timely treatment threatens the life of the patient.

Treatment consists in the appointment of thyreostatic drugs( eg, Tyrozol, Mercazolil), which block the synthesis of thyroid hormones, drugs of the beta-blocker group, which reduce the heart rate, palpitations, are used to treat arrhythmias.

Glucocorticosteroid hormones are also used to treat advanced adrenal insufficiency. To reduce the symptoms of intoxication, infusions of a large amount of liquid, electrolytes are used.

With increasing figures of blood pressure, antihypertensive drugs are used( drugs that reduce blood pressure).

If the patient is nervous, in the case of psychosis, tranquilizers are used.

In case of high fever, antipyretic agents are used, cooling procedures are applied( wiped with alcohol solutions, ice bubbles can be used to cool).

Thyrotoxic crisis is the hardest, life-threatening condition. Immediate hospitalization is necessary. It is extremely dangerous and unacceptable to have an independent treatment that can lead to the death of the patient. From auxiliary treatment in a hospital can recommend the use of neurotropic vitamin preparations( preparations of B vitamins: Milgamma, Neuromultivitis and others).

Complications of thyrotoxic crisis

Development of adrenal insufficiency, severe arrhythmias, progression of heart failure, which, if untimely treatment leads to the death of the patient.

Prevention of thyrotoxic crisis

Timely exposure of thyrotoxicosis is necessary. If surgery is planned on the thyroid( resection or extirpation of the thyroid gland) or planned treatment with radioactive iodine, it is necessary to pre-treat thyrotoxicosis with the achievement of a normal level of thyroid hormones. Treatment of thyrotoxicosis is carried out by thyreostatics( Tirozol, Merkazolil), which reduce the synthesis of thyroid hormones. Only after the achievement of euthyroidism is carried out surgical treatment or treatment with iodine.

Forecast of thyrotoxic crisis

Depends on how timely treatment is started. With timely adequate therapy, the prognosis is favorable. In the absence of treatment, the forecast is unfavorable.

Advice for the

racer Question: Why do I need a medication before the operative treatment on the thyroid?
Answer: If the patient, who is planning to undergo thyroid surgery, is in a state of thyrotoxicosis, preliminary medical treatment with thyreostatics is necessary before achieving euthyroidism. Only after this, it is possible to perform an operative intervention to avoid a thyrotoxic crisis.

Question: If there is a suspicion of developing a thyrotoxic crisis, is outpatient treatment possible?
Answer: No, treatment is possible only in conditions of resuscitation of the hospital, as this is a serious, life-threatening condition.

Doctor endocrinologist Artemyeva Marina Sergeevna