Storming Tori — Thyroid Storm
Everything accelerates: fever, tachycardia, delirium
Tori's thyroid has been running hot for months. Surgery throws gasoline on it, and every system in her body redlines at once.
Tori's untreated hyperthyroidism explodes after surgery. Temperature above 40°C, heart rate over 140, agitation and delirium. Cool her, beta-block her, block hormone synthesis with PTU, and give iodine only after PTU.
Read Storming Tori's full story →The story arc
The setup
Graves' disease she stopped treating, plus an emergency appendectomy.
The turn
Post-op she is restless, drenched in sweat, heat-intolerant and her heart rate will not come below 130.
The crisis
Temperature 40.6°C, heart rate 168 in atrial fibrillation, blood pressure falling, frankly delirious.
The save
Cooling measures without aspirin, propranolol for the heart rate, propylthiouracil, then iodine an hour later, plus corticosteroids.
NCLEX study section — Thyroid Storm
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Endocrine & Metabolic
Take this chapter into practice questions on the same topic.