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Hyperthyroidism, Thyroid Storm, and Graves Disease Follow-up

  • Author: Erik D Schraga, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
Updated: May 30, 2014

Further Outpatient Care

See the list below:

  • Patients with mild-to-moderate hyperthyroidism or Graves disease should follow up with their primary care physician or endocrinologist after a period of ED monitoring.

Further Inpatient Care

See the list below:

  • Admit patients with thyroid storm to the intensive care unit.
  • Severely thyrotoxic patients should be admitted to a monitored setting.
  • Confirm the diagnosis with laboratory analysis.
  • Clinical improvement should be evident within hours of initiating therapy.
  • Monitor therapy by laboratory values and clinical assessment. Titrate medications to optimize antithyroid and antiadrenergic effects.
  • Therapy may be required for 4-8 weeks.
  • Aggressively treat infection and any other underlying precipitant.


See the list below:

  • Initiate antithyroid therapy for patients with thyrotoxicosis.
  • Ensure hemodynamic stability prior to transfer.
  • Consider transfer if intensivist or endocrinologist is not available to assist inpatient management.


See the list below:

  • Surgical complications
    • Hypoparathyroidism
    • Damage to recurrent laryngeal nerve
    • Hypothyroidism with subtotal thyroidectomy
  • Development of hypothyroidism following radioiodine treatment
  • Visual loss or diplopia due to severe ophthalmopathy
  • Localized pretibial myxedema
  • High-output cardiac failure
  • Muscle wasting and proximal muscle weakness
  • Development of multiorgan failure in rare cases of thyroid storm[7]


See the list below:

  • Thyroid storm is usually fatal if untreated.
    • Overall rate of mortality due to thyroid storm is approximately 10-20% but has been reported as high as 75%; the precipitating factor or underlying illness is often the cause of death.
    • With early diagnosis and adequate treatment, the prognosis is good.

Patient Education

See the list below:

  • Stress the importance of medication compliance.
  • Provide return precautions including symptoms suggestive of secondary hypothyroidism and undertreated hyperthyroidism.
  • For patient education resources, see the Endocrine System Center, as well as Thyroid Problems and Thyroid Storm.
Contributor Information and Disclosures

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Howard A Bessen, MD Professor of Medicine, Department of Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Program Director, Harbor-UCLA Medical Center

Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Romesh Khardori, MD, PhD, FACP Professor of Endocrinology, Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

Robin R Hemphill, MD, MPH Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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