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B
Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.
2
- Graves' Disease is an autoimmune condition in which the patient produces autoantibodies to the thyrotropin receptor, which overstimulates the release of T4 and T3, resulting in hyperthyroidism and its associated clinical manifestations (anxiety, palpitations, weight loss, diaphoresis, diarrhea, tremors, etc...).
- Further, in Graves' Disease, patients may have exophthalmos and/or lid lag, which are findings that are more specific to Graves' Disease
than other causes of hyperthyroidism. This patient's constellation of symptoms is highly consistent with Graves' Disease.
1
Atenolol
Atenolol, a β-Adrenergic blocker, is prescribed to control the stimulation of the sympathetic nervous system that often occurs with hyperthyroidism. Atenolol manages tachycardia, nervousness, irritability, and tremors. It is considered the drug of choice for treating a patient diagnosed with hyperthyroidism, asthma, and heart disease. Methimazole is used to treat hyperthyroidism; however, it is not the drug of choice for patients with concurrent diagnoses of asthma and heart disease. Lugol's solution is an antithyroid drug that is used in treatment of thyrotoxicosis. Propylthiouracil, although appropriate for the treatment of hyperthyroidism, is not the drug of choice for a patient with concurrent diagnoses of asthma and heart disease.
4
Managing lifelong corticosteroid replacement
The patient with Addison's disease experiences hypofunctioning of the adrenal cortex, resulting in decreased production of glucocorticoids, mineral corticoids, and androgens. Patients with Addison's disease require lifelong glucocorticoid and mineral corticoid replacement therapy to avoid Addisonian crisis. Addisonian crisis is characterized by profound hypotension, dehydration, fever, tachycardia, hyponatremia, and hyperkalemia. Circulatory collapse may occur if the patient is treated inadequately. Although Addisonian crisis often is triggered by illness-related physiologic stress, and although avoiding infection is important, avoiding infection is of lower priority than managing lifelong corticosteroid replacement. Corticosteroid replacement must be increased during times of stress to prevent Addisonian crisis. Patients taking a mineralocorticoid should increase their salt intake. Emotional stress may contribute to the need for increased corticosteroid replacement. Stress management techniques are important. Practicing stress management techniques, however, is of lower priority than managing lifelong corticosteroid replacement.
thinning of hair, red cheeks, acne, buffalo hump, moon face, supraclavicular fat pad, increased body/facial hair, weight gain, purple striae on pendulous abdomen, echymosis from easy bruising, thin extremities w/ muscle atrophy, thin skin/subcutaneous tissue, slow wound healing