Sunday, May 8, 2011

Storms You Won't Find In A Weather Forecast

Hail storms, rain storms, thunder and lightning storms... even snow storms are something we're used to hearing about from day to day.  We turn on the news and a meteorologist or reporter tells us what kind of weather we had today, and what we might expect from the next day or week.  Those weather reports help us to plan and execute our day to day lives.  We depend on them.  Most of us wouldn't have a clue what to do if suddenly we were unable to predict the weather!

But there are other kinds of storms that you won't be hearing about in your local, regional or even national weather forecast. These kinds of storms affect us much more profoundly than mere rain or lightning...

Sometimes the body overreacts in a way that causes extreme production or dumping of something that is naturally already a part of our systems which work normally to keep us healthy.  When this happens we sometimes call this a "Storm".

I have friends that have dealt with these issues in the recent past, so for the next two days I'm going to tell you about two of them...

Thyroid Storm

Normally, our thyroids are small butterfly shaped glands in the front of our neck, just above the collar bone and under the voice box (larnyx).  Its job it to produce hormones that help to regulate our metabolism.  Thyroid hormones work to regulate the metabolism of every single cell in our bodies!  Without a thyroid to do this important work, we would die.

Sometimes things go wrong with a thyroid gland.  Often the gland may become inflammed, damaged, or simply stop working as it should.  We call this thyroid dysfunction.

There are many types of thyroid dysfunction.  Some types are caused by the immune system's attack on our glands.  Two of these attackers have interesting names:  Graves' disease (usually hypERthyroidism) and Hashimoto's thyroiditis (usually hypOthyroidism).  Some types are caused by small growths called nodules that can form in our glands.  These growths, or nodules, may or may not be cancerous, but there are two main types - hot nodules, and cold nodules.  A cold nodule is a spot of tissue that has stopped creating thyroid hormones.  You might think of it like being frozen so it can't function.  A hot nodule is a spot of tissue that is hyperactive and creating thyroid hormone - sometimes in excess.  It is working very hard and fast, like you would if you were trying to walk barefooted on hot concrete.  Sometimes thyroid dysfunction can be the result of injury, or even medicine or special dyes we are given for x-ray imaging.  Not eating enough, or properly can also cause thyroid dysfunction as can pregnancy and delivery, stress, infection or illness, or even simply palpating (touching or manipulating) the thyroid can also be risk factors for thyroid dysfunction... or storm.

Sometimes, when conditions are just right, the thyroid can cause a storm - a superload of thyroid hormone is either secreted or dumped into the system, causing an overwhelming response. A thyroid storm is much like driving your car with the accelerator pedal to the floor and no brakes.  It is uncontrollable and VERY dangerous.

The symptoms of thyroid storm include:

++ Increased heart rate which can result in tachycardia or even heart attack.
++ Increased blood pressure which can be severe and result in stroke or death.
++ Severe anxiety, delirium, psychosis
++ Increased body temperature which may feel like a fever.
++ Chest pain, difficulty breathing
++ Nausea, vomiting, diarrhea
++ Exaggerated reflexes
++ Exhaustion or fatigue

What happens?

Graves' Disease is a frequent cause of thyroid storm.  The gland is stimulated to overproduce thyroid hormone in such large amounts that metabolism is increased and symptoms occur. When Graves' Disease patients die, it is often the result of an unpredictable storm.

Hashimoto's Thyroiditis usually causes low thyroid, but in some cases toxicosis can occur and can result in thyroid storm symptoms.  Most often the thyroid is induced to "dump" a large amount of hormone spontaneously as a result of the illness/inflammation and its destructive action on the thyroid.

Hot nodules can be unpredictable and can spontaneously "dump" hormone into the system with little or no provacation.  While cold nodules often are left in the thyroid because they cause little trouble, hot nodules are often removed to keep the patient safe.

Thyroid surgery can result in storm when the thyroid gland is handled during the procedure causing it to react by dumping excess hormone.  Unfortunately patients are sometimes not informed of this complication and may become very frightened if it occurs... and rightly so.

Pregnancy and delivery are common times for thyroid storm to occur.  The stress on the body can stimulate autoimmune activity that results in the dumping of hormone into the system.  The same is true for illness or injury or surgery unrelated to the thyroid gland itself.

Withdrawal of anti-thyroid medications like those given for Graves' disease can result in a rebound effect and storm

Dyes injected into the system for X-ray imaging can sometimes cause a thryoid storm.  The dyes are iodine based and iodine is the fuel for the thyroid.  Giving dyes in some instances can be like tossing gasoline onto a fire.

Excess iodine, especially when given in the presence of autoimmune disease or a hot nodule can overfuel the thyroid resulting in the production of excess hormone.  Iodine supplementation should be done carefully and only with the supervision of a thyroid specialist to avoid this event.

Radioactive Iodine Ablation - this common treatment for Graves' disease involves ingesting large amounts of I-131 (radioactive iodine) which settles into the thyroid causing destruction of the gland.  One way to think of RAI is a bomb that goes off very slowly, over a period of days to years.  When this destruction happens the gland can react by dumping excessive amounts of hormone into the body resulting in symptoms.  Thyroid patients are rarely warned of this potential side effect in the United States.

Palpation or manipulation of the gland irritates it and it may react by dumping excess hormone, just as in a surgical setting.

If you suspect you or someone you know may be having a thyroid storm, it is vitally important that you seek immediate medical attention. Thyroid storm can happen very very quickly and is a very dangerous situation.

If you have reason to suspect thyroid storm you may want to call an ambulance.  If you choose to do this, be sure and inform them that you suspect a thyroid storm, and why.  This will help them in making decisions how to treat the patient.  Try to keep the patient calm and as relaxed and comfortable as physically possible.  While you are waiting for the ambulance to arrive, you can help to gather together a short written medical history of the patient as well as the names of any medications they may have taken, how much and when.  Note the time the patient last ate as well as the names and phone numbers of any current physicians.  Putting together this information will help the patient to concentrate on the task at hand instead of the increasing symptoms and feelings that may be similar to an enormous adrenaline rush.  

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