Acute conditions in medicine of thyroid gland

Overview

Acute conditions in medicine of thyroid gland include thyroid storm, myxoedema coma, acute hypocalcaemia following thyroid surgery, imminent suffocation and superior vena cava syndrome in rapidly growing goitre, sight -⁠ threatening Graves’ ophthalmopathy and acute purulent thyroiditis and its complications (acute mediastinitis and sepsis). As these are rare conditions, the management is often not fully evidence based and is rather empirical and based on pathophysiological principles. Thyroid storm is treated with intravenous methimazole, hydrocortisone and beta‑blockers, myxoedema coma with hydrocortisone and high‑dose levothyroxine and in individual cases in combination with triiodothyronine. In acute postoperative hypocalcaemia, calcium must be supplemented intravenously or orally (in mild cases) and if hypoparathyroidism is confirmed, calcitriol should be added. Rapidly growing goitre often has malignant etiology and when the fine needle aspiration bio­psy is not diagnostic, material for purpose of histological examination must be obtained and only after that corticosteroids may be administered. The patient with sight -⁠ threatening Graves’ ophthalmopathy must be immediately referred to a “thyroid eye centre”. Fine needle aspiration bio­psy with bacteriological examination of the obtained sample is the first step in the management of a patient with acute purulent thyroiditis fol­lowed by systemic antibio­tic treatment, abscess evacuation and drainage and intensive care if needed (sepsis).

Keywords:
thyroid storm –⁠ myxoedema coma –⁠ hypocalcaemia –⁠ hypoparathyroidism –⁠ anaplastic thyroid cancer –⁠ thyroid lymphoma –⁠ sight -⁠ threatening Graves’ ophthalmopathy –⁠ acute purulent thyroiditis