28 you F with no known PMH, p/w palpitations x 3 days after bus trip to Washington DC, states she is feeling “awful”, symptoms have been constant and worsened today. Also endorses b/l LE swelling, nausea, vomiting x1 per day, fatigue, diaphoresis, mild SOB. Notes generalized yellowing of skin. Denies CP, no fevers, no cough. No sick contacts, no travel outside of the country.
Endorses occasional etoh abuse, no tobacco, no other drug use
VS: 96.6, 147, 156/56, 22, 100% RA
Gen: anxious, diaphoretic, jaundice
HEENT: +scleral icterus, mmm
CVS: irregularly irregular, tachycardic, no m/r/g
Abd: soft, NTND, no appreciable hepatomegaly
Ext: 2+ pitting edema b/l
Neuro: A/Ox3, nonfocal
EKG: rapid afib
Negative urine pregnancy
A score of 45 or more is highly suggestive of thyroid storm; a score of 25 to 44 supports the diagnosis; and a score below 25 makes thyroid storm unlikely.
This patient has a score of 80, in patients with probable thyroid storm, which is a clinical diagnosis, you should go ahead and treat without confirmatory studies because mortality from this disease is very high (at least 30% with some sources asserting that delay of treatment may increase mortality to 75%)
1. Beta blockers (Propranalol), treats symptoms
2. Methimazole or PTU, block synthesis of thyroid hormone
3. Iodine, blocks release of thyroid hormone, this must be given after a synthesis blocking agent!!!
4. Steroids, block conversion of T4 to T3
Dr. Zara Mathews