Thyroid Storm and Hyperthyroidism

The Natural Thyroid Diet

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2. Diagnosis: Thyroid Storm

3. Condition:

4. Vital signs: q1-4h. Call physician if BP >160/90, <90/60; P >130, <50; R>25, <10; T >38.5 °C

5. Activity: Bed rest

6. Nursing: Cooling blanket prn temp >39°C, inputs and outputs. Oxygen 2 L/min by nasal canula.

7. Diet: Regular

9. Special Medications:

Thyroid Storm and Hyperthyroidism:

-Propylthiouracil (PTU) 1000 mg PO, then 50-250 mg PO q4-8h, up to 1200

mg/d; usual maintenance dose 50 mg PO tid OR -Methimazole (Tapazole) 30-60 mg PO, then maintenance of 15 mg PO qd-bid AND

-Iodide solution (Lugol's solution), 3-6 drops tid; one hour after propylthiouracil AND

-Dexamethasone (Solu-Medrol) 2 mg IV q6h AND -Propranolol 40-160 mg PO q6h or 5-10 mg/h, max 2-5 mg IV q4h or propranolol-LA (Inderal-LA), 80-120 mg PO qd [60, 80, 120, 160 mg].

-Acetaminophen (Tylenol) 1-2 tabs PO q4-6h prn temp >38°C. -Triazolam (Halcion) 0.125-0.5 mg PO qhs prn sleep OR -Lorazepam (Ativan) 1-2 mg IV/IM/PO q4-8h prn anxiety.

10. Extras: CXR PA and LAT, ECG, endocrine consult. If visual symptoms, obtain ophthalmology consult.

11. Labs: CBC, SMA 7&12; sensitive TSH, free T4. UA.

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