A 55 year old male patient underwent cholcystectomy for Gall stone calculus. During surgery the patient's pulse was irregulary irregular, 160/min, BP = 80/ 50 mm of Hg, temp.40o c On examination a swelling in the neck was found. Most likely diagnosis is
Thyroid storm It is an emergency due to decompensated hypehyroidism Treatment Non-selective beta blocker (Propanalol) - Most valuable measure in thyroid storm In thyroid storm most of the symptoms are because of adrenergic over activity due to increased tissue sensitivity to catecholamines in hypehyroidism This increased sensitivity is due to increased number of beta receptors Quick relief is obtained by blocking beta receptors Propyl thiouracil : Anti-thyrois drug of choice for thyroid storm. Reduces hormone synthesis as well as peripheral conversion of T4 to T3 Coicosteroids(Hydrocoisone) : Inhibits both release of thyroid hormone from the gland and peripheral conversion of T4 to T3 Iodides (Potassium iodide or ipranoic acid) : used to inhibit fuher hormone release from the gland Other measures : Diltiazem, if tachycardia is not controlled by Propanalol alone. Rehydration, anxiolytics, external cooling and appropriate antibiotics Ref: Harrison's 19th edition Pgno : 2296
Thyroid storm
Myocardial infarction
Arhmias
Stridor
Urology