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Thyroid Lab Tests to check

diagnose thyroid storm: usually HYPERthyroidism or Graves Disease or multinodular goiter but can also

Happen after surgery,infection etc.

Thyroid storm happens when your thyroid gland suddenly releases large amounts ofthyroid hormonein a

short period of time

Hypotheses include a rapid rate of increase in serum thyroid hormone levels, increased responsiveness

to catecholamines, or enhanced cellular responses to thyroid hormone [1]. The degree of thyroid

hormone excess (elevation of T4 and T3, suppression of TSH) typically is not more profound than that

seen in patients with uncomplicated thyrotoxicosis. However, one study found that while the total T4 and

T3 levels were similar to those seen in uncomplicated patients, the free T4 and free T3 concentrations

were higher in patients with thyroid storm

http://www.uptodate.com/contents/initial-and-reoperative-thyroidectomy?source=see_link

http://emedicine.medscape.com/article/850924-workup

Presently, no specific diagnostic criteria to establish the diagnosis of thyroid storm exist.

Burch and Wartofsky have constructed an excellent clinical diagnostic point scale to facilitate a

semiquantitative distinction between uncomplicated thyrotoxicosis, impending storm, and

established thyroid storm.[3]

Laboratory findings in thyroid storm are consistent with those of

thyrotoxicosis and include the following:

o Elevated T3 and T4 levels

o Elevated T3 uptake

o Suppressed TSH levels

o Elevated 24-hour radioiodine uptake Elevated T4 and decreased TSH are the only abnormal findings needed for conformation of

thyrotoxicosis. Treatment should not be withheld for any laboratory confirmation of

hyperthyroidism when thyroid storm is suspected clinically. A 2-hour radioiodine uptake is

advisable if thyroid storm is suspected and no past history of hyperthyroidism exists.

Other abnormal laboratory values that point toward decompensation of homeostasis include

the following:

o Increased BUN and creatinine kinase

o Electrolyte imbalance from dehydration, anemia, thrombocytopenia, and leukocytosis

o Hepatocellular dysfunction as shown by elevated levels of transaminases, lactate

dehydrogenase, alkaline phosphatase, and bilirubin

o

Elevated calcium levelso Hyperglycemia

blood cell count,

electrolyte levels,

http://www.emedicinehealth.com/script/main/art.asp?articlekey=126563&ref=127000http://www.emedicinehealth.com/script/main/art.asp?articlekey=126563&ref=127000http://www.emedicinehealth.com/script/main/art.asp?articlekey=126563&ref=127000http://www.uptodate.com/contents/thyroid-storm/abstract/1http://www.uptodate.com/contents/thyroid-storm/abstract/1http://www.uptodate.com/contents/thyroid-storm/abstract/1http://www.uptodate.com/contents/initial-and-reoperative-thyroidectomy?source=see_linkhttp://www.uptodate.com/contents/initial-and-reoperative-thyroidectomy?source=see_linkhttp://emedicine.medscape.com/article/850924-workuphttp://emedicine.medscape.com/article/850924-workuphttp://www.emedicinehealth.com/script/main/art.asp?articlekey=94020http://www.emedicinehealth.com/script/main/art.asp?articlekey=94020http://www.emedicinehealth.com/script/main/art.asp?articlekey=86874http://www.emedicinehealth.com/script/main/art.asp?articlekey=86874http://www.emedicinehealth.com/script/main/art.asp?articlekey=86874http://www.emedicinehealth.com/script/main/art.asp?articlekey=94020http://emedicine.medscape.com/article/850924-workuphttp://www.uptodate.com/contents/initial-and-reoperative-thyroidectomy?source=see_linkhttp://www.uptodate.com/contents/thyroid-storm/abstract/1http://www.emedicinehealth.com/script/main/art.asp?articlekey=126563&ref=127000

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blood sugar level,

liver function, and

thyroid hormone levels. Circulating Free T3, T4 and TSH

Calcium Levels

Treatment and supportive measures can include:

A complete evaluation to determine the cause of thyroid storm

Intravenous fluids andelectrolytes

Oxygen if needed

Fever control with antipyretics (fever-reducing medications) and if needed cooling blankets

Intravenous corticosteroids such ashydrocortisone

Medications to block the production of thyroid hormones, such aspropylthiouracil(PTU) or

methimazole(Northyx, Tapazole)Iodide to block thyroid hormone release

Drugs called beta-blockers, such aspropranolol(Inderal) to block the action of thyroid hormones on

the body

Treatment of heart failure if present

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