Management of thyrotoxic crisis.

The thyrotoxic crisis is a medical emergency caused by an exacerbation of the hyperthyroid state characterized by de- compensation of one or more organ systems. Early recognition and aggressive treatment are fundamental in limiting the morbidity and mor- tality associated with this condition. The crisis has an abrupt onset, and is evoked by a precip- itating factor such as infectious diseases, ke- toacidosis, acute trauma, thyroidal surgery, 131-I radio-metabolic treatment, administration of iodine-containing materials (amiodarone), parturition. The clinical picture is characterized by four main features: fever, tachycardia or supraventricular arrhythmias, central nervous system symptoms and finally gastrointestinal symptoms. The diagnosis of thyrotoxic crises is often made on the basis of clinical findings alone, since it is difficult in most emergency departments to obtain rapid confirmatory labo- ratory or nuclear medicine tests. The ultra- sound thyroid scan, if available in the emer- gency room, may suggest an hyperthyroid state showing typical images of Basedow's dis- ease or nodular goiter with their characteristic color-Doppler pattern of hyperactivity, easily distinguishable from a normal gland. The prin- ciples of thyroid storm treatments are: reduc- tion of circulating TH's levels; inhibition of the peripheral effects of circulating thyroid hor- mones (TH); supportive care, in order to re- verse systemic decompensation and treatment of the underlying precipitating event.