0071643192.pdf

■ Vasopressors for hypotension

■ Hydrocortisone empirically for adrenal insufficiency

A 75-year-old female presents to the ED with the chief complaint of

lethargy, weakness, and weight loss. On exam she has sleepy-looking eyes,

a palpable goiter, and atrial fibrillation on the cardiac monitor. Her TSH is

markedly elevated. What is her diagnosis?

Apathetic hyperthyroidism.

Hyperthyroidism and Thyroid Storm

SYMPTOMS

■ Anxiety and restlessness
■ Manic behavior or frank psychosis
■ Weakness
■ Weight loss
■ Apathetic hyperthyroidismis seen in elderly patients: Lethargy, weak-
ness, weight loss, blepharoptosis (eye drooping), and atrial fibrillation
with CHF

EXAM

■ Febrile and diaphoretic
■ Tachycardia
■ Exopthalmus
■ Goiter
■ Myopathy

DIFFERENTIAL

■ Most commonly presents in patients with Graves disease and set off by a
stressful event, such as:
■ Infection
■ DKA or hypoglycemia
■ Withdrawal of antithyroid drugs
■ Contrast or radioactive iodine administration
■ CVA or MI
■ Trauma
■ Emotional stress
■ Palpation of thyroid

DIAGNOSIS

Confirmed by an elevated free T 4

TREATMENT

■ Supportive therapy
■ Oxygen
■ Cooling
■ Hydration and electrolyte replacement
■ Digitalis and diuretics for AFib and CHF

ENDOCRINE, METABOLIC, FLUID, AND

ELECTROLYTE DISORDERS

Levothyroxine (synthroid) is

synthetic T 4. Levothyroxine

overdose is usually

asymptomatic because the

breakdown of T 4 occurs more

rapidly than the conversion to

T 3. Overdose is not a cause of

thyroid storm.