Thyroid storm: modern understanding, diagnosis and management approaches
The review deals with one of the most severe critical conditions in the practice of an endocrinologist — thyroid storm (TS). Modern ideas about the etiology and pathogenesis of this complication are given, and the features of the clinical course are analyzed. TS is a life-threatening condition that can develop in a patient with uncompensated thyrotoxicosis, it is characterized by a sharp exacerbation of clinical manifestations and progressive disorders of homeostasis; in the absence of adequate treatment, as a rule, it ends lethally. You should make it a rule: in case of a sudden deterioration in the condition of thyrotoxicosis patient, it is always necessary to keep in mind the risk of developing TS, while the symptoms of the disease that provoked it may come to the fore. Most experts believe that in doubtful cases it is better to make a mistake in the assumption of TS presence at the moment or the threat of its development and after all to start intensive care than to miss the diagnosis. Owing to the creation and introduction of antithyroid drugs, β-adrenoblockers, antipsychotics and other therapeutic measures into wide clinical practice, mortality in TS has dramatically decreased and amounts to about 10 %. Reliable predictors of poor prognosis are progressive hyperthermia, tachyarrhythmia and disorders of the central nervous system, as well as jaundice. Death can occur due to heart and/or respiratory failure, shock, multiple organ failure, hyperthermia, disseminated intravascular coagulation, sepsis or other complications. After all, if patients survive, some of them experience irreversible disorders, such as posthypoxic encephalopathy, cerebrovascular pathology, muscle atrophy, psychosis, or renal failure. Based on official international recommendations, the principles of diagnosis, treatment and prevention of this critical condition are considered. World experience shows that emergency multimodal therapy of thyroid storm can reduce mortality to 10–20 %.
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