Date: [Date of encounter]
Patient: [Patient Name]
Chief Complaint:
Document the presenting signs and symptoms suggestive of thyroid storm, such as:
Altered mental status (confusion, agitation, delirium, coma)
Cardiovascular symptoms (tachycardia, atrial fibrillation, heart failure)
Gastrointestinal symptoms (diarrhea, nausea, vomiting)
Neuromuscular symptoms (tremor, weakness)
Fever (may not be present in all cases)
Diaphoresis (sweating)
History of Present Illness:
Onset, duration, and progression of symptoms.
Presence of any precipitating factors (e.g., infection, surgery, withdrawal of thyroid medication).
Known history of thyroid disease (Graves’ disease, toxic nodular goiter, etc.).
Medication history (including current thyroid medications).
Past Medical History:
Underlying medical conditions that may contribute to or worsen thyroid storm (e.g., heart disease, liver disease, adrenal insufficiency).
Surgical history (relevant procedures on the thyroid gland or other major surgeries).
Family History:
Family history of thyroid disease.
Social History:
Recent stress or emotional distress (potential triggers).
Physical Exam:
Vital signs (tachycardia, fever, hypertension or hypotension)
General examination (assess for signs of dehydration, malnutrition)
Cardiovascular examination (murmurs, heart failure signs)
Neurological examination (altered mental status, tremor)
Skin examination (warm, moist skin)
Laboratory Tests:
Thyroid function tests (TFTs): Markedly elevated free T4 (fT4) and suppressed TSH.
Thyroid-binding globulin (TBG): May be elevated or low depending on the cause of thyroid storm.
Complete blood count (CBC): May show leukocytosis (high white blood cell count).
Basic metabolic panel (BMP): May reveal electrolyte imbalances (e.g., hypokalemia, hyperglycemia) and possible signs of organ dysfunction (elevated liver enzymes, renal insufficiency).
Coagulation studies (PT, PTT): May be prolonged in severe cases.
Blood cultures: To rule out infection as a potential trigger.
Other tests (as indicated): Chest X-ray, ECG (electrocardiogram).
Assessment:
Clinical suspicion of thyroid storm based on history, physical exam findings, and characteristic symptoms.
Confirmation with abnormal thyroid function tests (elevated fT4, suppressed TSH).
Identification of potential precipitating factors.
Evaluation for severity of thyroid storm and potential complications (heart failure, arrhythmias, coma).
Plan:
Urgent Management: Aims to rapidly decrease thyroid hormone levels and control symptoms. This may involve:
Intravenous medications:
Antithyroid drugs (methimazole, propylthiouracil)
Beta-blockers to control heart rate and blood pressure
Glucocorticosteroids (e.g., hydrocortisone) to address potential adrenal insufficiency
Supportive care:
Intravenous fluids for hydration and electrolyte correction
Cooling measures to address fever
Monitoring of vital signs and cardiac rhythm
Definitive Treatment: Once the storm is controlled, address the underlying cause of hyperthyroidism (e.g., radioactive iodine ablation, surgery).
Follow-up: Close monitoring of thyroid function and clinical status until euthyroidism (normal thyroid function) is achieved.
Patient Education:
If possible, educate the patient (or family members) about thyroid storm, its symptoms, and the importance of seeking immediate medical attention in case of recurrence.
Disclaimer: This template is for informational purposes only and should be adapted to fit the specific needs of each patient. Thyroid storm is a medical emergency requiring prompt diagnosis and aggressive treatment. Consultation with an endocrinologist and critical care specialist is crucial for optimal management