Further Outpatient Care
See the list below:
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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.
Further Inpatient Care
See the list below:
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Admit patients with thyroid storm to the intensive care unit.
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Severely thyrotoxic patients should be admitted to a monitored setting.
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Confirm the diagnosis with laboratory analysis.
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Clinical improvement should be evident within hours of initiating therapy.
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Monitor therapy by laboratory values and clinical assessment. Titrate medications to optimize antithyroid and antiadrenergic effects.
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Therapy may be required for 4-8 weeks.
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Aggressively treat infection and any other underlying precipitant.
Transfer
See the list below:
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Initiate antithyroid therapy for patients with thyrotoxicosis.
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Ensure hemodynamic stability prior to transfer.
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Consider transfer if intensivist or endocrinologist is not available to assist inpatient management.
Complications
See the list below:
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Surgical complications
Hypoparathyroidism
Damage to recurrent laryngeal nerve
Hypothyroidism with subtotal thyroidectomy
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Development of hypothyroidism following radioiodine treatment
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Visual loss or diplopia due to severe ophthalmopathy
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Localized pretibial myxedema
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High-output cardiac failure
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Muscle wasting and proximal muscle weakness
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Development of multiorgan failure in rare cases of thyroid storm [23]
Prognosis
See the list below:
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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.
Patient Education
See the list below:
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Stress the importance of medication compliance.
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Provide return precautions including symptoms suggestive of secondary hypothyroidism and undertreated hyperthyroidism.
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For patient education resources, see the Endocrine System Center, as well as Thyroid Problems and Thyroid Storm.
