causes of thyroid storm
(A) ineffective pre-operative hormonal control (B) manhandling of the thyroid gland during surgery (C) parathyroid tail left after surgery (D) Poor Preoperative preparation of the patient
(D) Answer- D. Poor Preoperative preparation of the patientThis is a rare but life-threatening complication of thyrotoxicosis.The most prominent signs are fever, agitation, delirium, tachycardia or atrial fibrillation and, in the older patient, cardiac failure. Thyrotoxic crisis is a medical emergency and has a moality of 10% despite early recognition and treatment.It is most commonly precipitated by an infection in a patient with previously unrecognized or inadequately treated thyrotoxicosis.It may also develop in known thyrotoxicosis sholy after thyroidectomy in an ill-prepared patient or within a few days of 131I therapy, when acute radiation damage may lead to a transient rise in serum thyroid hormone levels.Patients should be rehydrated and given propranolol, either orally (80 mg 4 times daily) or intravenously (1-5 mg 4 times daily). Sodium iodate (500 mg per day orally) will restore serum T3 levels to normal in 48-72 hours.This is a radiographic contrast medium that not only inhibits the release of thyroid hormones but also reduces the conversion of T4 to T3 and is, therefore, more effective than potassium iodide or Lugol's solution.