Hyperthyroidism

Hyperthyroidism is a common form of thyroid disease that mimics many of the common complaints in the ED. Most of these complaints refer to the overt or sometimes undiagnosed state of hypermetabolism caused by excess thyroid hormones. The diagnosis of hyperthyroidism is often challenging because of many physical and even psychiatric complaints. The most common worldwide cause of thyrotoxicosis is Graves' disease. Thyroid storm is considered in patients presenting with profound hyperpyrexia, tachycardia, altered mental status, and an underlying history of thyroid disease. The diagnosis of thyroid storm is primarily a clinical one aided by selected laboratory tests. Appropriate clinical suspicion and rapidly available laboratory tests measuring sensitive TSH and free T4 levels make the diagnosis of hyperthyroidism and thyroid storm possible in the ED setting. Radioactive iodine is the most common treatment for hyperthyroidism in a stable patient; however. the use of other therapeutic modalities can be considered. In the acutely ill patient who is suspected to have thyroid storm, therapy should begin immediately. First-line treatment typically includes the use of PTU, inorganic iodides, and β-blocking agents along with supportive care.