Hyperthyroidism, Thyroid Storm, and Graves Disease Follow-up

Updated: Apr 10, 2017
  • Author: Erik D Schraga, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Follow-up

Further Outpatient Care

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  • 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.
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Further Inpatient Care

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  • 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.
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Transfer

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  • 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.
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Complications

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  • 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 [14]
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Prognosis

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  • 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.
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Patient Education

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  • 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.
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