Recognizing Thyroid Storm in the Neurologically Impaired Patient

Catherine Harris

J Neurosci Nurs. 2007;39(1):40-42, 57. 

In This Article

Case Resolution

Soon after the nurse noted Mrs. R's "scratch" murmur, the medical team was consulted to evaluate her. After reconstructing the history of the patient's stay in the hospital and the discovery of the TSH levels, the team hypothesized that the clinical picture could be consistent with thyroid storm. Endocrinology staff were immediately consulted. When the endocrinology team came to assess the patient, they concurred with the clinical diagnosis of thyroid storm. Mrs. R was treated with intravenous lopressor (7.5 mg every 6 hr around the clock) and high-dose dexamethasone (20 mg every 12 hr). Her methimazole was increased to 10 mg three times a day. The nurses were educated on the importance of this drug in preventing thyrotoxicosis. The patient was then transferred to the medicine service for further management.

Mrs R was successfully treated for thyroid storm on the medicine service and returned to the floor, only to suffer from a mucous plug that caused her to stop breathing. She was found unresponsive and pulseless. She was successfully resuscitated and transferred to the medical intensive care unit. A little over 2 weeks later she finally transferred back to the floor. The dexamethasone was discontinued, and the lopressor was switched to the oral equivalent and regulated at 100 mg twice a day. After spending almost 2 months in the hospital, Mrs. R, completely exhausted but alert and oriented to her surroundings, was discharged to a rehabilitation unit.

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