robsanchez
Forum Junior
Topics: 13
Posts: 50
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which is the Tx of thyroid storm?
which step in the Thyroid hormone metabolism do you need to block?
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| MIG
Forum Junior
Topics: 6
Posts: 63
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Rx of thyroid storm ( which is potentially fatal thyrotoxoc crisis) is IODIDE , it will inhibits the iodination of tyrosines , thus decreasing the supply of stored thyroglobulin.
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| asmi
Forum Hero
Topics: 1043
Posts: 4,609
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Medical Care: Management of thyroid storm is a multi-step process. Blocking the synthesis, secretion, and peripheral action of the thyroid hormone is the ideal therapy.
Blocking Thyroid Hormone Synthesis
Antithyroid compounds propylthiouracil (PTU) and methimazole (MMI) are used to block the synthesis of the thyroid hormone.
PTU also blocks peripheral conversion of T4 to T3 and hence is preferred in thyroid storm over MMI.
A history of hepatotoxicity or agranulocytosis from previous thioamide therapy precludes use of PTU and MMI.
Blocking Thyroid Hormone Secretion After initiation of antithyroid therapy, hormone release can be inhibited by large doses of iodine, which reduce thyroidal iodine uptake. Lugol solution or saturated solution of potassium iodide can be used.
Iodine therapy should be administered after approximately 1 hour following administration of PTU or MMI; iodine used alone helps to increase thyroid hormone stores and may increase the thyrotoxic state.
The iodinated x-ray contrast agent, sodium ipodate, can be administered instead of iodine and also inhibits peripheral conversion of T4 to T3.
Blocking Peripheral Action of Thyroid Hormone
Propranolol is the drug of choice to counter peripheral action of thyroid hormone. Propranolol blocks beta-adrenergic receptors and prevents conversion of T4 to T3. It produces dramatic improvement in clinical status and greatly ameliorates symptoms.
Propranolol produces the desired clinical response in thyroid storm only after large doses.
Presently, esmolol is the ultra-short-acting beta-blocking agent used successfully in thyrotoxicosis and thyroid storm.
Supportive Measures
Aggressive fluid and electrolyte therapy is needed for dehydration and hypotension. This excessive hypermetabolic state, with increased intestinal transit and tachypnea, leads to immense fluid loss. Fluid requirements may increase to 3-5 L/day. Therefore, invasive monitoring is advisable in elderly patients and in those with congestive cardiac failure.
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| robsanchez
Forum Junior
Topics: 13
Posts: 50
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yes you all are right.
The steps in the thyroid hormone synthesis that you have to block are
1.Synthesis
2.secretion
3.conversion of T4 to T3 via 5'deiodinase in peripheral tissue
this is the correct TX
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