Fever and Tremor

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    Fever and Tremor

    38yoF with hypothyroidism prevents with drowsiness, palpitations and tremors. Pt with fever  to 38C, Hr to 120.


    Thyroid storm.

    Precipitating events:
    – stopped taking anti-thyroid meds
    – IV contrast
    – thyroid hormone overdose
    – pna
    – cva
    – PE
    – pregnancy
    – diabete

    Thyroid storm is a clinical diagnosis, the hallmark is CNS dysfunction
    – no lab test can distinguish thyroid storm from simple hyperthyroidism

    Other diagnostic criteria:
    – temp >38
    – tachycardia out of proportion to the fever
    – exaggerated peripheral manifestations of thyrotoxicosis, including tremor and weakness

    Thyrotoxicosis is assoc with:
    – elev T4
    – decreased TSH
    – hyperglycemia
    – hypercalemia
    – elevated LFTS

    Management:
    1) supportive care, IVF, corticosteroids (decrease peripheral conversion of T4 to T3), no ASA
    2) blockade of peripheral thyroid hormone effects: propranolol 1mg to 10mg, titrated to symptoms
    3) blockade of thyroid hormone synthesis: PTU (inhibits peripheral conversion of T3 to T3), methimazole
    $) blockade of thyroid hormone release: iodine given 1 hour after PTU
    5) identify and treat precipitating events.

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