Hyperthyroidism, Thyroid Storm, and Graves Disease Follow-up

Updated: Apr 03, 2018
  • Author: Erik D Schraga, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
  • Print
Follow-up

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 [19]

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