THYROID EMERGENCIES
Emergencies related to thyroid gland diseases are infrequently observed in clinical practice. They are caused by either overt dysfunction or marked enlargement of the gland that jeopardizes the life of patients and require admission to intensive care units (ICU) in most cases.
The first description of thyroid diseases as they are known today was that of Graves’ disease by Caleb Parry in 1786, but the pathogenesis of thyroid disease was not discovered until 1882-86. Thyroidectomy for hyperthyroidism was first performed in 1880, and antithyroid drugs and radioiodine therapy were developed in the early 1940s. Thomas Curling first described hypothyroidism (myxedema) in 1850 and the cause and suitable treatment were established after 1883.
Thyroid-related emergencies are caused by overt dysfunction of the gland which is so severe that requires admission to intensive care units (ICU) frequently.
Severe excess or defect of thyroid hormone is a rare condition, which jeopardizes the life of patients in most cases. Both hypothyroid coma (HC) and thyrotoxic storm (TS) are triggered by precipitating factors, which occur in patients with severe hypothyroidism or thyrotoxicosis, respectively. The pillars of HC therapy are high-dose L-thyroxine and/or tri-iodothyroinine; IV glucocorticoids; treatment of hydro-electrolyte imbalance (mainly, hyponatremia); treatment of hypothermia; often, endotracheal intubation and assisted mechanic ventilation are needed. Therapy of TS is based on beta-blockers, thyrostatics, and IV glucocorticoids; eventually, a high dose of iodide compounds or lithium carbonate may be of benefit. Surgery represents the gold standard treatment in patients with euthyroid massive nodular goiter, although new techniques – e.g., percutaneous laser ablation – are helpful in subjects at high surgical risk or refusing operation.
Satyendra Dhar MD,
