<prompt> Thyroid storm is seen in -Thyroid surgeryNeonatal thyrotoxicosisPeri-operative infectionAll of the above  <response>: 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 beatsminute. Congestive heart failure. Hypotension Cardiac arrhythmia Death from cardiovascular collapse may occur. 60 percent having severe tachycardia andor 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 andor 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 andor 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, 