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

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.