DR Medhat MRCP

o Thyrotoxic crisis (thyroid storm) :
- It`s a life-threatening emergency occur in patients with unrecognized thyrotoxicosis or
severe poorly controlled disease.
- Precipitating factors include
‣ Intercurrent illness.
‣ Surgery.
‣ 131 I therapy.
- C/P :
‣ Hyperpyrexia (> 38.5 C 0 ).
‣ Profuse sweating.
‣ Extreme restlessness.
‣ Psychosis.
‣ Confusion.
‣ Dysrrhythmias.
‣ Hypertension & heart failure manifistations
‣ Shock , coma & death if left untreated.
+ Abnormal LFT.
Investigations of hyperthyroidism :
i. Thyroid function tests (TFT) :
- High free T4&/T3 (T3 thyrotoxicosis with normal T4 is more common in
toxic adenoma).
- Low TSH ( unless the cause is TSH-secreting pituitary tumour).
ii. Thyroid antibodies :
- Anti-thyroid peroxidase Abs : in 50% of Grave`s disease
- TSH receptor-stimmulating antibodies. In 90% of Grave`s disease.
سؤال : scan iii. Radioisotope ( 99m Tc or 131 I) uptake
- Uniform uptake Grave`s disease.
- Patchy irregular appearance toxic multinodular goiter.
- Localized uptake with suppressed activity elsewhere toxic adenoma
- Low uptake thyroiditis.