What signs and symptoms indicate to the nurse the client is experiencing thyroid storm?
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Act quickly to address this potentially fatal condition. Show Takeaways:
Your patient, Barbara Dulaney*, was admitted last night to the progressive care unit for right lower lobe pneumonia. She’s 51 years old, smokes two packs of cigarettes per day, and was diagnosed with Graves’ disease 10 years ago. Her treatment includes I.V. fluids, antibiotic therapy, albuterol via nebulizer, acetaminophen as needed for fever and pain, and benzonatate as needed for cough. When you enter the room, Mrs. Dulaney tells you she’s feeling anxious and having heart palpitations. She’s restless and has trouble lying still during your assessment, which reveals diaphoresis, tachycardia, rales in the lower lobe of the right lung, exophthalmos, goiter, and hand tremors. Her vital signs are heart rate 138 BPM, temperature 101.9° F (38.8° C), BP 164/98 mmHg, and oxygen saturation 94% on 2 liters of oxygen per minute via nasal cannula. On a scale of 0 to 10, Mrs. Dulaney reports chest pain at 6 and abdominal pain at 8. She also says she’s had nausea for the past 2 hours. You call the hospitalist and administer acetaminophen for fever and pain per protocol. On the sceneResults from tests ordered by the hospitalist are: chest X-ray shows no cardiac enlargement or pulmonary edema; ECG shows sinus tachycardia; and laboratory tests indicate troponin I within normal limits, mild leukocytosis, elevated T3 and T4, decreased thyroid–stimulating hormone levels, and mildly elevated aspartate aminotransferase and alanine aminotransferase levels. As a result, cardiac injury is ruled out, and Mrs. Dulaney is diagnosed with thyroid storm. Your immediate priorities are to decrease Mrs. Dulaney’s heart rate and body temperature and to prevent vascular collapse. You place a cooling blanket over her, decrease the room temperature, and provide I.V. fluids at 100 mL/hr. You administer ordered medications: methimazole (antithyroid), dexamethasone (glucocorticoid), and propranolol (beta blocker). The patient’s pneumonia, likely the thyroid storm’s precipitating factor, will continue to be treated with I.V. antibiotics. To help manage Mrs. Dulaney’s anxiety, you provide a calm environment by dimming the lights and providing reassurance. OutcomeMrs. Dulaney is transferred to the ICU to be montiored for potential complications, including heart failure, cardiac arrythmias, neurovascular decline, and shock. She is given iodine therapy after the methimazole to inhibit further release of thyroid hormone. Her serum hormone levels may take up to a week to decrease to baseline. After hospital discharge, Mrs. Dulaney will need to follow up with her endocrinologist for medication management and likely radioactive iodine therapy, to destroy the thyroid gland, or thyroidectomy, for permanent hyperthyroid treatment. EducationHyperthyroidism from Graves’ disease is routinely treated with antithyroid medications and beta blockers. However, factors such as infection, stress, sudden cessation of antithryroid medicine, and trauma can increase serum thyroid hormone levels, potentially leading to thyroid storm, which has a high mortality rate and warrents agressive treatment. Excessive thyroid hormone affects all organ systems, including cardiac, neurovascular, and GI. Initial thyroid storm symptoms may go unnoticed, especially in the presence of illness such as pneumonia, so early recognition is critical. Nursing education for patients with hyperthyroidism should include medication adherence, signs of increased thyroid hormone levels, and when to seek medical help. *Name is fictitious. Wendy R. Downey is an assistant professor at Radford University School of Nursing in Radford, Virginia. ReferencesHinkle JL, Cheever KH. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 14th ed. Philadelphia, PA: Wolters Kluwer; 2018. Idrose AM. Acute and emergency care for thyrotoxicosis and thyroid storm. Acute Med Surg. 2015;2(3):147-57. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343-1421. A thyroid storm -- or thyroid crisis -- can be a life-threatening condition. It often includes a rapid heartbeat,
fever, and even fainting. Your thyroid is a master at managing your body. The hormones produced by this gland located at the base of your
neck help control your metabolism. That’s how quickly your body processes food, converts it to energy, and runs your organs. A thyroid storm can be brought on by a number of ailments. One of them, Graves’ disease, causes the thyroid to overproduce hormones
(hyperthyroidism). When it happens suddenly, you can have a thyroid storm. It can come on within hours and may require immediate hospitalization. If this happens to you or someone you know, call 911 immediately. A thyroid storm can also be triggered by other conditions. They include: Thyroid storms must be handled quickly when they happen. Doctors can treat them with antithyroid medications, potassium iodide, beta blockers, and steroids. You’ll usually begin to improve within 1 to 3 days. Once the crisis has passed, you should be evaluated by an endocrinologist (gland doctor) to determine if more treatment is needed. Thyroid storms don’t have to be a long-term concern. They can usually be prevented from happening again with medication and therapy. People with an overactive thyroid typically live long and healthy lives when the condition is properly managed. If you have concerns, make sure to discuss them with your doctor. What are the signs of a thyroid storm?The sudden and drastic increase in thyroid hormones can produce many effects, including fever, sweating, vomiting, diarrhea, delirium, severe weakness, seizures, irregular heartbeat, yellow skin and eyes (jaundice), severe low blood pressure, and coma. Thyroid storm requires immediate emergency care.
What is a thyroid storm nursing?The most severe form of hyperthyroidism is thyrotoxic crisis, known also as thyroid storm or thyrotoxicosis. This condition, which occurs when the body can no longer tolerate the hypermetabolic state, is a nursing and medical emergency and is fatal if not treated.
What happens during thyroid storm?Overview. Thyroid storm (thyroid crisis) is a potentially life-threatening condition for people who have hyperthyroidism. Thyroid storm happens when your thyroid gland suddenly releases large amounts of thyroid hormone in a short period of time. If you have thyroid storm, you will need emergency medical treatment.
What are the typical signs noted with thyrotoxicosis or thyroid storms?Patients with thyrotoxicosis most commonly present with signs and symptoms related to excess thyroid hormone including: weight loss with a normal or increased appetite, heat intolerance with increased sweating, palpitations, tremor, anxiety, proximal muscle weakness, alopecia and increased fatigability.
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