Thyroid storm NCLEX review notes for students who are prepping to take the NCLEX exam. The endocrine system is made-up of many disorders, such as thyroid storm which is a complication of untreated hyperthyroidism. This NCLEX review is part of an endocrine series of thyroid disorders.
As a student prepping for NCLEX, it is very important you know the details of thyroid storm and how to care for a patient experiencing this condition.
As the nurse taking care of the patient in thyroid storm it is important you understand the signs and symptoms, pathophysiology, causes, nursing interventions, and medical treatments.
Don’t forget to take the quiz on thyroid storm.
In this NCLEX review, you will learn the following:
-Pathophysiology of the thyroid storm
-Signs and symptoms of thyroid storm
-Causes of thyroid storm
-Medications for thyroid storm
Lecture on Thyroid Storm
Definition: Life-threatening complication that develops in someone who has hyperthyroidism which is an excessive secretion of thyroid hormones (T3 and T4).
It is usually because hyperthyroidism is not being treated properly, the patient is undiagnosed, or the patient experienced an illness.
In addition, thyroid storm can develop after a thyroidectomy due to the thyroid being manipulated during removal which can cause high amounts of T3 and T4 to enter into the blood stream. However, it is rare because today patients are placed on medications to help combat this.
Causes of Thyroid Storm
Patients will already have hyperthyroidism along with any of the following:
- got an illness or experienced trauma/stress (septic, DKA, surgery, trauma to the gland)
- suffers from Grave’s Disease that is under treated or they became sick
- not taking antithyroid medications properly
- taking medications that increase thyroid hormones (Salicylates: ASA)
- radioactive iodine therapy (CT scan or as treatment) remember the thyroid loves iodine and uses it to make thyroid hormone
Signs & Symptoms of Thyroid Storm
The patient will have typical hyperthyroidism symptoms but they will be SEVERE to the point of death…remember the function of T3 and T4 is to increase body’s metabolism and temperature and to stimulate the sympathetic nervous system (this will be happening at an accelerated rate).
Remember this condition as: A violent storm on the body at an accelerated rate.
- Fever (not just heat intolerance)
- Hypertension—going to exhaust the heart to the point of failure (CHF or MI)
- Tachycardia— going to exhaust the heart to the point of failure (CHF or MI)
- Increase respirations—due to the body working so hard and it needs more oxygen and nutrients…will get respiratory failure if not treated fast
- Very restless, irritable, confused …this will progress to seizures, delirium, coma
Nursing Interventions for Thyroid Storm
- Monitor HR, BP, RR (respiratory failure…may need mechanical ventilation), EKG, Temperature
- Keep environment quiet and patient cool (cooling blankets and sedatives as prescribed)
- No foods containing iodine (seafood…seaweed, dairy, eggs)
Pharmacological Management of Thyroid Storm
- Need to decrease the thyroid hormone:
- Antithyroid medications (block synthesis) :
- Tapazole “Methimazole”: has fewer side effects than PTU…not for first trimester of pregnancy
- PTU “Propylthiouracil”: can be used during 1st trimester…watch for liver failure
Side Effects with these medications: Agranulocytosis and thrombocytopenia and watch for toxicity which will present as signs and symptoms of HYPOTHYROIDISM: slow heart rate, intolerance to cold, drowsy
- Iodide solution (block secretion)
- Lugol’s solution: Side effects: taste changes metal taste in mouth
2. Decrease fever:
Tylenol NO Salicylates or cooling blankets
3. Decrease effects of thyroid hormones on the body by blocking peripheral conversion of T3 and T4:
- Beta Blockers: Inderal (not for people with asthma or history of bronchospasm…watch in diabetics can mask hypoglycemia)
4. Prevent further secretion and conversion of thyroid hormones by suppressing immune system with:
- Glucocorticoids (Dexamethasone )
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