Thyrotoxicosis (Thyroid Storm) Nursing Care Plan Notes



Thyroid storm is a life-threatening condition in which patients with underling thyroid dysfunction inhibit exaggerated signs and symptoms of hyperthyroidism. Thyroid storm is precipitated by stressors such as infection, trauma, DKA, surgery, heart failure, or stroke. The condition can result from discontinuation of antithyroid medication or as a result of untreated or inadequate treatment of hyperthyroidism. The excess thyroid hormones increase metabolism and affect the sympathetic nervous system, thus increasing oxygen consumption and heat production and altering fluid and electrolyte levels.


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Signs And Symptoms
  • Sudden onset of fever
  • Tremors
  • Flushing
  • Profuse palm sweating
  • Tachydysrhythmias
  • Extreme restlessness
  • Nausea
  • Vomiting
  • Diarrhea
  • Weight loss
  • Fatigue
  • Muscle weakness
  • Atrophy
Physical Examination
Vital signs
  • Systolic hypertension or hypotension
  • HR: tachycardia disproportionate to the degree  of fever
  • RR: >20 breaths/ min
  • Temperature >102.2 °F can be higher
  • Agitated
  • Tremulous
  • Delirious coma
  • Bounding pulses
  • Systolic murmur
  • Widening pulse
  • Weak thready pulses
  • Tachycardia
  • Crackles may be present
  • Increased bowel sounds
  • Thyroid may be enlarged or nodular
Acute Care Patient Management

Nursing Diagnosis: Decreased cardiac output related to increased cardiac work secondary to increased adrenergic activity; Deficient fluid volume secondary to increased metabolism and diaphoresis.

Outcome Criteria
  • Patient alert and oriented
  • Peripheral pulses palpable
  • Lung clear to auscultation
  • Urine output 30 ml/hr
  • Absence of life-threatening dysrhythmias
Patient Monitoring
  1. Continuously monitor ECG for dysrhythmias or HR ? 140 beats/min that can adversely affect cardiac output and monitor for ST segment changes indicative of myocardial ischemia.
  2. Continuously monitor oxygen saturation with pulse oximetry.
  3. Continuously monitor pulmonary artery pressure.
  4. Monitor fluid volume status; measure urine output hourly and determine fluid balance every 8 hours.
Patient Assessment
  1. Assess cardiovascular status; extra heart sounds, complaints of orthopnea or dyspnea on exertion.
  2. Assess hydration status because dehydration can further decrease circulating volume and compromise cardiac output.
  3. Assess for pressure ulcer development secondary to hypoperfusion.
Diagnostic Assessment
  2. Review serial serum electrolytes, serum glucose, and serum calcium levels to evaluate the patient’s response to therapy.
  3. Review serial ABGs for hypoxemia and acid-base imbalance, which can adversely affect cardiac function.
  4. Review serial chest radiographs for cardiac enlargement and pulmonary congestion.
Patient Management
  1. Administer dextrose-containing intravenous fluids as ordered to correct fluid and glucose deficits.
  2. Carefully assess the patient for heart failure or pulmonary edema.
  3. Dopamine may be used to support blood pressure.
  4. Provide supplemental oxygen as ordered to help meet increased metabolic demands.
  5. Once the patient is hemodynamically stable, provide pulmonary hygiene to reduce pulmonary complications.
  6. If the patient is in heart failure, typical pharmacologic agents for treatment of heart failure may also be indicated.
  7. Reduce oxygen demands by decreasing anxiety, reduce fever, decrease pain, and limit visitors if necessary.
  8. Anticipate aggressive treatment of precipitating factor.
  9. Institute pressure ulcer strategies.