Thyroid Hormone Toxicity Workup

  • Author: Lisandro Irizarry, MD, MPH, FAAEM; Chief Editor: Asim Tarabar, MD   more...
 
Updated: May 2, 2012
 

Laboratory Studies

  • Most asymptomatic patients do not require diagnostic testing, especially very early after exposure.
  • The following tests are indicated in symptomatic patients:
    • Complete blood count
    • Electrolytes (eg, calcium, magnesium, phosphorous)
    • Urinalysis
    • Serum acetaminophen level (in patients with intentional exposures and suicidal ideations)
    • Arterial blood gas (ABG)
    • T3, T4, and T3 resin uptake (RU) levels may be sent 2-6 hours postingestion; however, remember the following:
      • These levels offer no aid in the acute phase of clinical management.
      • These levels are of no value in determining prognosis.
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Other Tests

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Procedures

  • Lumbar puncture (LP) should be considered in patients with hyperthermia and change of mental status to rule out CNS infection.
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Contributor Information and Disclosures
Author

Lisandro Irizarry, MD, MPH, FAAEM  Chair, Department of Emergency Medicine, Brooklyn Hospital Center; Assistant Professor, Department of Emergency Medicine, Weill Cornell School of Medicine

Lisandro Irizarry, MD, MPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Nadine A Youssef, MD  Assistant Professor of Emergency Medicine, Tufts University, Department of Emergency Medicine

Nadine A Youssef, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Anton A Wray, MD, FACEP  Clinical Assistant Professor of Emergency Medicine, Weill Cornell Medical College; Assistant Residency Director, Department of Emergency Medicine, Brooklyn Hospital Center

Anton A Wray, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey Glenn Bowman, MD, MS  Consulting Staff, Highfield MRI

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Fred Harchelroad, MD, FACMT, FAAEM, FACEP  Director of Medical Toxicology, Allegheny General Hospital

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References
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  8. Bosse GM, Matyunas NJ. Delayed toxidromes. J Emerg Med. Jul-Aug 1999;17(4):679-90. [Medline].

  9. Lehrner LM, Weir MR. Acute ingestions of thyroid hormones. Pediatrics. Mar 1984;73(3):313-7. [Medline].

  10. Mariotti S, Martino E, Cupini C, Lari R, Giani C, Baschieri L, et al. Low serum thyroglobulin as a clue to the diagnosis of thyrotoxicosis factitia. N Engl J Med. Aug 12 1982;307(7):410-2. [Medline].

  11. Seger D. Endocrine principles. In: Goldfrank L, ed. Goldfrank's Toxicologic Emergencies. 5th ed. New York, NY: McGraw-Hill; 1994:338-90.

  12. Singh GK, Winterborn MH. Massive overdose with thyroxine,--toxicity and treatment. Eur J Pediatr. Jan 1991;150(3):217. [Medline].

  13. Tunget CL, Clark RF, Turchen SG, Manoguerra AS. Raising the decontamination level for thyroid hormone ingestions. Am J Emerg Med. Jan 1995;13(1):9-13. [Medline].

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