Thyrotoxicosis

Objectives

Recognise and manage the thyrotoxic patient on Ops

Scope

Recognition and initial treatment of thyrotoxicosis on Ops, when thyroid function testing is unlikely to be available.

Audience

Healthcare providers.

Initial Assessment & Management

Clinical features:

• Tachycardia
• Sweaty
• Tremor
• Weight loss
• Agitation
• Anxiety
• GI upset
• Occasionally goitre
• Orbital or periorbital inflammation, swelling, proptosis (may be asymmetric)

Where available, expect raised thyroid hormone levels, suppressed TSH and clinical features. Use reference ranges which accompany the assay you have available.

It may be necessary to treat based on clinical features only.

Consider early specialist support via reach back, especially if results and clinical picture don’t fit.

Other important investigations:

• Pregnancy test if relevant
• FBC, UE, LFT
• ECG

Advanced Assessment & Management

Treatment:

• Beta blocker – first line: oral propranolol 20mg TDS (adjust according to response)
• Alternatives: IV metoprolol, nadolol or labetalol
  • IV labetalol (5mg/ml, 20ml ampules) bolus 12.5 -25mg, according to response (should not exceed 100mg) slow push over 5mins. Repeat every 8 hours

Prolonged Casualty Care

• Refer to next role for prompt initiation of antithyroid drugs

Causes:

• Autoimmune (Grave's or Hashimoto's)
• Large iodine load (e.g. following contrast CT)
• Hyperemesis in pregnancy
• Infection