A)
Etiology: Most commonly associated with hyperthyroidism (Grave's
> Toxic Multinodular Goiter and Toxic Adenoma)
B) Diagnosis: Fever, tachycardia, agitation,
confusion, coma, hypotension (high output failure), diarrhea, vomiting,
weakness, heat intolerance, tremor, dyspnea, seizure, goiter, lid
lag, tremor, ophthalmopathy, diaphoresis, hyperreflexia, inc pulse
pressure, inc T4 or inc T3 (5-10%), inc T3RU, dec TSH, inc 24 hr.
radioiodine uptake.
C) Management: (Identify and treat precipitating
event)
1) Potassium iodide (SSKI or Lugol's) 2) Propylthiouracil (PTU)
or Methimazole 3) Beta Blockage with Inderal 4) Hydrocortisone IVPB;
5) Hyperthermia with Tylenol, ice and/or cooling blanket 6) Volume
and electrolyte replacement prn.
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