32. Неотложная помощь при тиреотоксическом кризе.

1. Supportive measures

1. Manage patient in the critical care area
2. Supply high-flow oxygen
3. Monitor: ECG, vital signs, pulse oximetry
4. Establish peripheral IV line
5. IV fluids:

• dextrose-saline by slow infusion
• Correct volume depletion cautiously to avoid precipitating or worsening heart failure.

1. Labs:

• FBC
• Urea, electrolytes, creatinine
• Liver panel
• Thyroid screen for TSH, free T4

1. CXR for evidence of heart failure and infection
2. ECG: look for ischemia, infarction or dysrhythmia
3. Urinalysis by dipstick reagent and culture and sensitivity if sepsis is suspected.
4.  Correct precipating factors such as sepsis, acute MI
5.  Administer paracetamol, tepid sponging or other cooling techniques to relieve fever.

1. Drug therapy

1. Beta-blockers
   • Crucial even in the presence of high cardiac output heart failure
   • Give ultra-short acting IV Esmolol, test dose 250mg/kg followed by infusion of 50mg/min if available or
   • Give IV Propranolol 1mg q 5min until severe tachycardia is controlled. If patient is able to tolerate orally, then Propranolol 60mg PO q 4h or 80mg PO q 8h can be given

1. Dexamethasone:

• 2mg IV to provide glucocorticoid support;
• also blocks conversion of free T4 to free T3

1. Antithyroid drugs

PTU –Propylthiouracil

• Blocks iodination as well as the conversion of T4 to T3
• Dosage: 400-600mg stat PO or via Ryle’s tube, followed by 200-300 mg q 4h

Lugol’s iodine

• Iodine solution inhibits the release of thyroid hormone ; must give 1-2 hours
• Dosage: 5 drops PO or via Ryle’s tube q 12 h
• If nil by mouth: give IV sodium iodide 1g/500ml saline q 12h

1. treat other cardiovascular complications with conventional means; eg Digoxin, diuretics.

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