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Hyperthyroidism, Emergency Medicine

Rita K. Cydulka and Christopher S. Campbell Reviewed 06/2017
 


Basics

Description

  • Excessive thyroid hormone production results in a continuum of disease caused by both the direct physiologic effect of thyroid hormones as well as increased catecholamine sensitivity...

Diagnosis

Thyroid storm is a life-threatening condition, which may be precipitated by: 
  • Infection

  • Trauma

  • Diabetic ketoacidosis

  • Organophosphate intoxication

  • Cytotoxic chemotherapy

  • Myocardial infarction

  • Cerebr...

Treatment

Pre-Hospital

Stabilization and supportive care 

Initial Stabilization/Therapy

  • Airway, breathing, and circulation management

  • Cardiac monitor

  • Supplemental oxygen

  • IV fluids

  • Initiate cooling measures:

    • A...

Follow-Up

Disposition

Admission Criteria

  • Thyroid storm

  • Requiring IV medications to control heart rate

  • Significantly symptomatic or unstable patients

Discharge Criteria

Minimal symptoms that respond well to ...

Pearls and Pitfalls

  • Thyroid storm can be fatal. Diagnosis requires a high level of suspicion and treatment often needs to be started presumptively

  • Radioactive iodine is never a treatment option in the ...

Additional Reading

  • Bahn  RS, Burch  HB, Cooper  DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: Management guidelines of the ATA and AACE. Endocr Pract.  2011;17(3):456–520.

  • Klubo-G...

Codes

ICD9

  • 242.20 Toxic multinodular goiter without mention of thyrotoxic crisis or storm

  • 242.90 Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or stor...

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