How is thyrotoxic storm during thyroid surgery prevented?

Updated: Feb 27, 2020
  • Author: Pramod K Sharma, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Preoperative awareness of the hyperthyroid patient and appropriate medical treatment are the keys preventing thyrotoxic storm. Patients undergoing thyroidectomy for persistent thyrotoxicosis require treatment based on the time available and the severity of symptoms. The goal is to restore a state as close to euthyroid as possible before surgery. Medical management is directed at targets of the thyroid hormone synthetic, secretory, and peripheral pathways. These include thioamides (methimazole, propylthiouracil [PTU]), which affect synthesis.

PTU also inhibits peripheral deiodination (thyroxine [T4] to triiodothyronine [T3]). Iodine used at supraphysiologic doses decreases synthesis of new thyroid hormone (the Wolff-Chaikov effect), and it has an onset of action within 24 hours and a maximum effect at 10 days. Beta-blockers should be given to every thyrotoxic patient unless contraindicated (eg, congestive heart failure [CHF]). High doses of glucocorticosteroids impair peripheral conversion of T4 to T3 and are used for when thyrotoxicosis is severe and when rapid management is necessary. Morbidity and mortality rates in adequately prepared patient are low.

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