Thyroid storm is seen in -

Ans. is 'd' i.e., All of the above o Thyroid storm is a rare, life-threatening condition characterized by severe clinical manifestations of thyrotoxicosis.Risk factorso Although thyroid storm can develop in patients with long-standing untreated hyperthyroidism (Graves' disease,, toxic multinodular goiter solitary? toxic adenoma), it is often precipitated by* an acute event such as# Thyroid or nonthyroidal surgery;# Traum# Infection# An acute iodine load# Parturition# Irregular use or discontinuation of antithyroid drugs.o The advent ofappropriate preoperative preparation of hyperthyroid patients undergoing nonthyroidal surgery or thyroidectomy for hyperthyroidism has led to a dramatic reduction in the prevalence ofsurgically-induced thyroid storm.Clinical featureso Patients with severe and life-threatening thyrotoxicosis typically have an exaggeration of the usual symptoms of hyperthyroidism.Symptoms and signso Cardiovascular symptoms in tachycardia can 140 beats/minute.# Congestive heart failure.# Hypotension# Cardiac arrhythmia# Death from cardiovascular collapse may occur.# >60 percent having severe tachycardia and/or atrial fibrillation. o Hyperpyrexia to 104 to 106degF.o Agitationo Anxietyo Deliriumo Psychosiso Stuporo Comao Altered mentationLaboratory findings# Low thyroid-stimulating hormone (TSH)# High free thyroxine (T4) and/or triiodothyronine (T3) concentrations.o The degree of thyroid hormone excess typically is not more profound than that seen in patients with uncomplicated thyrotoxicosis.o Other nonspecific laboratory findings may include:# Mild hyperglycemia# Mild hypercalcemia# Abnormal liver function tests, leukocytosis, or leukopenia.Diagnosiso The diagnosis of thyroid storm is based upon the presence ofsevere and life-threatening symptoms {hyperpyrexia, cardiovascular dysfunction, altered mentation) in a patient with biochemical evidence of hyperthyroidism (elevation of free thyroxine and/or triiodothyronine and suppression of thyroid-stimulating hormone ).Treatmento The principles of treatment:# A beta blocker to control the symptoms and signs induced by increased adrenergic tone.# A thionamide to block new hormone synthesis.# An iodine solution to block the release of thyroid hormone.# An iodinated radiocontrast agent (if available) to inhibit the peripheral conversion of thyroxine (T4) to triiodothyronine (T3).# Glucocorticoids to reduce T4-to-T3 conversion, promote vasomotor stability, and possibly treat an associated relative adrenal insufficiency.# Bile acid sequestrants to decrease enterohepatic recycling of thyroid hormones,