The main manifestations are high fever, body temperature above 39℃, atypical clinical symptoms, hyperhidrosis, vomiting, diarrhea, tachycardia, irritability, delirium and coma, and the mortality rate is extremely high. Therefore, patients with hyperthyroidism should be vigilant and start with prevention. In case of crisis, comprehensive measures should be taken to rescue immediately. Generally from the following aspects.
(1) Reduce the release and synthesis of thyroid hormone as soon as possible. Propylthiouracil is the first choice to inhibit the synthesis of thyroid hormone, and trimethoprim, methimazole and carbimidazole can also be used. The dosage of propylthiouracil or trimethoprim is 200-300mg, and the dosage of methimazole or carbimidazole is 20-30mg, once every 6 hours, orally. Sometimes a larger dose is needed, such as 600 ~ 1000 mg of propylthiouracil per day, or 60 ~ 100 mg of methimazole per day, which takes effect after 1 hour. If you are unconscious, you can grind the medicine and inject it through the stomach tube.
There is a crisis after operation, and thiourea drugs are no longer needed. In order to inhibit the release of thyroid hormone, the secretion of thyroid hormone can be blocked with inorganic iodine solution by intravenous or oral administration within 1 hour after antithyroid drug treatment. Methods: potassium iodide 1g or sodium iodide 0.25g was added to 10% glucose solution, and it was intravenously dropped every 8 ~12 hours. You can also take about 30 drops of compound iodine solution orally every day and gradually stop using it within 2 weeks. If the symptoms are not improved or aggravated after 1 ~ 2 days of comprehensive treatment, it is suggested that the decomposition of thyroid hormone may be slow, and plasma clearance or dialysis treatment may be considered to remove excessive thyroid hormone in blood circulation.
Plasma removal method is to draw 500ml blood each time, separate and remove plasma, and put red blood cells into compound sodium chloride injection for reinfusion, and repeat every 4 ~ 6 hours 1 time. Dialysis, including peritoneal dialysis or hemodialysis, can reduce the plasma T4 concentration.
(2) rapidly blocking the release of catecholamine. In the absence of heart failure, asthma and atrioventricular block, it is very important to use adrenergic receptor blockers, which should be carried out under ECG monitoring if necessary. General propranolol 10 ~ 40 mg, every 4 ~ 6 hours 1 time; Or 0.5 ~ 1 mg intravenous drip, repeat treatment or add slow intravenous drip when necessary. Propranolol 1 ~ 5 mg intravenous drip, or 40 ~ 80 mg orally every 6 hours, the symptoms can be improved after taking the medicine for several hours. Intramuscular injection of 1 ~ 2 mg of risepine every 4 ~ 6 hours can consume catecholamine stored in tissues, and its effect can be blocked when the dose is large, or guanethidine of 1 ~ 2 mg/kg body weight can be taken orally every day.
(3) Adrenal cortical hormone. It can not only inhibit the release of thyroid hormone, but also reduce the transformation from T4 to T3, and correct the relative deficiency of adrenal cortex in crisis. Commonly used drugs are hydrocortisone 200 ~ 500mg per day, or dexamethasone 15 ~ 30mg per day, and leave it alone.
For patients with high fever, sweating and coma. Dexamethasone 5 ~ 10 mg can be given intravenously, and then hydrocortisone or dexamethasone can be used to maintain the static point. After the symptoms are relieved, they will gradually reduce or even stop.
(4) symptomatic treatment. Including the use of drugs or physical methods to reduce body temperature, avoid using salicylate to reduce temperature, because it can compete with thyroid binding protein for the combination of T3 and T4, so that free hormones increase, and a large number of salicylates also increase metabolic rate. Inhale oxygen, replenish water, electrolyte, vitamins, etc. Use sedatives when you are upset and artificial hibernation when necessary. Give high calorie, high protein and high sugar in diet, strengthen supportive therapy and maintain water and electrolyte balance.
If there are infected people, give appropriate antibiotics. Take the initiative to remove incentives.
After comprehensive treatment, the serum T3 concentration can generally return to the normal level within 24 ~ 48 hours. It should also be noted that comprehensive treatment must be continued before reaching the normal metabolic state, and iodine and adrenocortical hormone should be gradually stopped after reaching the normal metabolic state.