A patient underwent thyroidectomy for hypehyroidism. Two days later he was presented with features of thyroid storm. What is the most likely cause?
Poor antibiotic coverage
Rough handling during surgery
Removal of parathyroid
Inadequate preoperative preparation
Answer DThyrotoxic crisis (storm)- This is an acute exacerbation of hypehyroidism.It occurs if a thyrotoxic patient has been inadequately prepared for thyroidectomy and is now extremely rare.Features: They present in 12-24 hours after surgery; with severe dehydration, circulatory collapse, hypotension, hyperpyrexia, tachypnoea, hyperventilation, palpitation, restlessness, tremor, delirium, diarrhea, vomiting, and cardiac failure; later coma.Treatment: Injection hydrocoisone, oral antithyroid drugs, tepid sponging of the whole body, beta-blocker injection, oral iodides, a large amount of IV fluids for rehydration, digitoxin, cardiac monitor, often ventilator suppo, with close observation.