Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Hyperthyroidism, Thyroid Storm, and Graves Disease Follow-up

  • Author: Erik D Schraga, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
 
Updated: Aug 05, 2016
 

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.
Next

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.
Previous
Next

Transfer

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.
Previous
Next

Complications

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[12]
Previous
Next

Prognosis

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.
Previous
Next

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.
Previous
 
Contributor Information and Disclosures
Author

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.

References
  1. Williamson S, Greene SA. Incidence of thyrotoxicosis in childhood: a national population based study in the UK and Ireland. Clin Endocrinol (Oxf). 2010 Mar. 72(3):358-63. [Medline].

  2. Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y. Factors Associated With Mortality of Thyroid Storm: Analysis Using a National Inpatient Database in Japan. Medicine (Baltimore). 2016 Feb. 95 (7):e2848. [Medline].

  3. Swee du S, Chng CL, Lim A. Clinical characteristics and outcome of thyroid storm: a case series and review of neuropsychiatric derangements in thyrotoxicosis. Endocr Pract. 2015 Feb. 21 (2):182-9. [Medline].

  4. Hamnvik OP, Larsen PR, Marqusee E. Thyroid dysfunction from antineoplastic agents. J Natl Cancer Inst. 2011 Nov 2. 103(21):1572-87. [Medline]. [Full Text].

  5. FDA MedWatch Safety Alerts for Human Medical Products. Propylthiouracil (PTU). US Food and Drug Administration. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm164162.htm. Accessed: June 3, 2009.

  6. Kreisner E, Lutzky M, Gross JL. Charcoal hemoperfusion in the treatment of levothyroxine intoxication. Thyroid. Feb 2010. 20(2):209-12. [Medline].

  7. Vyas AA, Vyas P, Fillipon NL, Vijayakrishnan R, Trivedi N. Successful treatment of thyroid storm with plasmapheresis in a patient with methimazole-induced agranulocytosis. Endocr Pract. 2010 Jul-Aug. 16(4):673-6. [Medline].

  8. Alfadhli E, Gianoukakis AG. Management of severe thyrotoxicosis when the gastrointestinal tract is compromised. Thyroid. 2011 Mar. 21(3):215-20. [Medline].

  9. Bahn RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract. 2011 May-Jun. 17 (3):456-520. [Medline]. [Full Text].

  10. Tun NN, Beckett G, Zammitt NN, Strachan MW, Seckl JR, Gibb FW. Thyrotropin Receptor Antibody Levels at Diagnosis and After Thionamide Course Predict Graves' Disease Relapse. Thyroid. 2016 Aug. 26 (8):1004-1009. [Medline].

  11. Rabon S, Burton AM, White PC. Graves' Disease in Children: Long Term Outcomes of Medical Therapy. Clin Endocrinol (Oxf). 2016 May 12. [Medline].

  12. Chong HW, See KC, Phua J. Thyroid storm with multiorgan failure. Thyroid. Mar 2010. 20(3):333-6. [Medline].

  13. Basaria S, Cooper DS. Amiodarone and the thyroid. Am J Med. 2005 Jul. 118(7):706-14. [Medline].

  14. Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA. 2006 Mar 1. 295(9):1033-41. [Medline].

  15. Cooper DS. Antithyroid drugs. N Engl J Med. Mar 2005. 352(9):905-17. [Medline].

  16. McKeown NJ, Tews MC, Gossain VV, Shah SM. Hyperthyroidism. Emerg Med Clin North Am. 2005 Aug. 23(3):669-85, viii. [Medline].

  17. Pimentel L, Hansen KN. Thyroid disease in the emergency department: a clinical and laboratory review. J Emerg Med. 2005 Feb. 28(2):201-9. [Medline].

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.