Thyroid Storm Case 3

A 44-year-old woman is bought to hospital by her sister who is worried about her. She has felt very hot, had diarrhoea and vomiting and also been confused. She has described seeing things that are not there. Four days ago she underwent an uneventful arthroscopy on her left knee. She has a history of hyperthyroidism but is uncompliant with treatment, has no allergies and no recent foreign travel.

  1. 1. Question

    She is mumbling under her breath, is clinically jaundiced, has a large goitre, resting tremor and her temperature is 38.5oC. Her chest is clear, pulse 140 (irregular), blood pressure 160/85 and no pitting oedema peripherally. Her knee has pain-free movements and the scars are clean.

    List at least four causes for patients to present with high temperatures to the ED.

  2. 2. Question

    Describe your initial resuscitation and investigation of this patient.

  3. 3. Question

    The ECG shows atrial fibrillation. The CXR, glucose and VBG are unremarkable.

    Does this patient have thyroid storm? Qualify your answer.

  4. 4. Question

    What blood result is needed before starting treatment?

    • 1.
    • 2.
    • 3.
    • 4.
    • 5.
  5. 5. Question

    Which of the following is contraindicated in thyroid storm?

    • 1.
    • 2.
    • 3.
    • 4.
    • 5.
  6. 6. Question

    Your junior doctor asks you to explain the treatment of thyroid storm. You explain that the treatment of thyroid storm targets four areas. What are the areas?

  7. 7. Question

    After starting the esmolol she experiences worsening difficulty in breathing and has marked wheeze. The SHO stops the esmolol as they are concerned about the possibility of bronchospasm. Is there any alternative that could be used for helping control the heart rate?