Thyroid Storm
Introduction
In the emergency department, failure to recognize thyroid storm, also known as thyrotoxic crisis, can be lethal. Although the incidence of thyroid storm is relatively low, the mortality rate approaches 20% (Carroll & Matfin, 2010). It is theorized that causes of thyroid storm can be from a myriad of conditions: from myocardial infarction, to sepsis, and even Graves Disease. Although this diagnosis accompanies a high mortality rate, the treatment and management of this multi-organ process can be corrected. The astute provider can effectively diagnose, treat and refer this life-threatening condition.
Pathophysiology
The pathophysiology of thyroid storm is related to the checks and balance system of the thyroid. Under normal circumstances the hypothalamus releases Thyroid Releasing Hormone (TRH) which then triggers the pituitary gland to release Thyroid Stimulating Hormone (TSH). The TSH then triggers to thyroid to release T3 (triiodothyronine) and T4 (thyroxine). These hormones are made by the thyroid from dietary intake of iodine. T4 is the concentrated version of T3, and is changed into T3 in the body. T3 and T4 are then used by the body to regulate metabolism. If the levels of T3 and T4 are too high, the hypothalamus will then stop the production of TRH, thus stopping the cascade of the thyroid hormone. In the process of thyroid storm however, the checks and balance system has gone askew. The production of T3 and T4, although high, is not responding to the decrease in TRH. The continued production of T3 and T4 causes these levels to skyrocket, thus creating a state of hyper-metabolism (Carroll & Matfin, 2010). Patients with mildly elevated T3/T4 levels may be diagnosed with hyper...
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Dr.Bain ordered a CT scan of Cynthia’s chest to rule out a possibility of an aneurism. Dr. Bain also did another CT scan of Cynthia’s abdomen to evaluate her liver. Additional lab work and thyroid testing was done. Around 5:00pm she was discharged with instructions to follow up with her primary care physician Leah Avera, M.D within one week. In Cynthia’s discharge summary that was signed by Dr. Pesante, states, in part, "it just seems like Cynthia’s problem may have more so been either some kind of infectious process or possibly a thyroid
Thyroid hormones are Tyrosine based hormones that require triidothyronine (T3) and Thyroxine (T4). These hormones are produced by the thyroid gland. The Thyroid gland is primarily known for the regulation of metabolism, as well as proper production of T3 and T4. Iodine is the main component that is needed. Dysfunction of Iodine can lead to decreased production of T3 and T4, resulting in enlarged thyroid tissue and even lead to thyroid diseases. In order for the thyroid hormone to function adequate amount of Thyroxine (T4) should be found within the blood. Thyronines on the other hand act on nearly all cells inside the body. Their function is to increase basal metabolic rate, affect protein synthesis, help regulate long bone growth, and increases the body’s ability of being sensitive to catechoalmines. Thyroid hormones are highly essential for proper development and differentiation of all cells within the body. Thyroid hormones also play a role in the regulation of protein, fat, and metabolism of carbohydrates and vitamins. Various physiological and pathological effects serve to influence thyroid hormone synthesis.
Graves’ disease is an autoimmune disease that was discovered by Robert Graves in 1835. Graves’ disease is an autoimmune disease in which the body's immune system attacks the thyroid gland and causes hyperthyroidism. Graves’ disease occurs when the antibodies like thyroid-stimulating immunoglobulin and thyrotropin receptor antibodies (TRAbs) attack the thyroid gland as if it were a foreign object or a virus of some sort. This disease is the most common type of hyperthyroidism. Attacking the thyroid gland in such a manner makes it excessively overproduce the hormone thyroxine which controls the body’s metabolic rate. Heightened activity of the thyroid can increase the body’s metabolism by 60% to 100%. (Weeks 34-35).
Today in America thyroid disease is becoming a much larger issue and the worse part of this problem is that many people are not yet diagnosed. This is due to the lack of education and awareness about thyroid disease. There are many different types of diseases but the one that I am passionate about is hypothyroidism. Hypothyroidism, or underactive thyroid is when the thyroid is no longer able to produce triiodothyronine, also known as T3 and thyroxine, also referred to as T4. Some of the symptoms include unexpected weight gain, tiredness, depression, or slow movements and thoughts. Most of the time many people notice the way that their bodies act on what they are feeling to their physicians. Many Americans struggle with this disease that
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Research by Hotchkiss, Monneret, & Payen’s (2013) has revealed that sepsis is an immunosuppressive disorder, therefore patients can benefit from immunostimulatory therapies used to treat those who have lowered immune systems. Accordingly, focusing on boosting the immune system has been shown to decrease mortality in patients (Hotchkiss et al. 2013). Hotchkiss et al. (2013) announces that while these statistics are encouraging, the mortality rate is still considered high and further research and techniques are needed in order to continue the downward trend. Hotchkiss et al. (2013) states that it is unclear why some patients survive sepsis and others do not recover. Until the true cause of death in sepsis is understood, the best course of action is prevention, early detection, and immune system support.
Follicular cells use iodine from your blood to make thyroid hormones that help regulate a persons’ metabolism. If you have too much of these hormones, it is called hyperthyroidism. Hyperthyroidism symptoms include irregular or rapid heartbeat, trouble sleeping, nervousness, weight loss, and constantly feeling too warm.
Heart Failure Overview WebMD Reviewed by Thomas M. Maddox, MD on May 28, 2012 http://www.webmd.com/heart-disease/heart-failure/heart-failure-overview
The thyroid gland plays a major role in the endocrine, thyroxine, triiodothyronine and metabolism system. The gland can be found in the front of the neck and above where the collar bones meet. The thyroid gland controls the body by releasing T4 and T3 hormones. Controlling metabolism plays an important role when regulating mood, weight,
The thyroid is a small gland at the base of the neck. The thyroid is shaped like a butterfly. It releases hormones that deliver energy to the cells of the body (Shomon). The thyroid releases two hormones called T3 (triiodothyronine) and T4 (thyroxine). The hormones control rates in the body such as, how fast the heart beats and how fast calories are burned. These activities make up the metabolism (“Publications”).
The thyroid is often referred to as the most important gland in the body. This is because it produces thyroxine (T4), triiodothyronine (T3), and calcitonin hormones. These hormones regulate a variety of tasks including cellular activity, brain function, metabolism, immune system, and the stimulation of the heart. (Friedman) One may take all of this for granted, however it is very important to take care of the thyroid gland. To produce these vital hormones, the thyroid requires iodine. The thyroid follicular cells trap iodine (as Iodide, I- ) by absorbing it from the blood in exchange for Na+. Next, the thyroid gathers the iodine, concentrating it 30-50 times more than in the blood. The iodide is then used to synthesize T4 and T3, and these hormones are released into the bloodstream. (Nussey) Without iodine, none of this would be possible...
... American Diabetes Association. “Diabetes Statistics.” American Diabetes Association. Page - American Diabetes Association.
Approximately 20 million Americans are currently suffering from thyroid disease. This common, yet subtle disease can be have an immense impact on one’s health and lifestyle. I chose to research thyroid disease because I have had blood tests done in speculation of this disease because of the similar symptoms I was experiencing. Although I do not have thyroid disease, I am curious about how it affects the body and why this disease often goes undiagnosed. This system involving the thyroid is crucial in regulating the body’s hormones and keeping them.
25 November 2011. “Vitamin D Deficiency.” webmd.com. Retrieved April 24, 2019. WebMD, 13 July 2009.