Emergency Medicine Cases

Ep 211 Thyrotixicosis and Thyroid Storm: Recognition and Management

Dec 30, 2025
Dr. George Willis, an emergency medicine physician, and Dr. Alyssa Louis, an intensivist, share their expertise on thyroid emergencies. They explore the complexity of diagnosing thyroid storm and thyrotoxicosis, emphasizing when to act before lab results. Key insights include the significance of using POCUS for rapid decision-making and the importance of the medication sequence for treatment. They discuss the risks associated with beta blockers, particularly in patients with low ejection fraction, and the nuances of effective cooling and agitation management.
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ADVICE

Treat On Suspicion, Don’t Wait For Labs

  • If thyroid storm is on your differential for a crashing patient, treat empirically and do not wait for labs.
  • Start the thyroid bundle early while you stabilize ABCs and look for triggers.
INSIGHT

Elderly Can Have ‘Apathetic’ Presentation

  • Apathetic thyrotoxicosis in the elderly can present with fatigue, AF, heart failure, and minimal hyperactivity.
  • Maintain suspicion and send thyroid studies for unexplained AF or disproportionate CHF in older patients.
ANECDOTE

Surprising AP Thyrotoxicosis Catch

  • George Willis recounts diagnosing apathetic thyrotoxicosis by chance when testing for other causes of fatigue.
  • He was surprised to get low TSH with elevated free T4 on reflex lab testing.
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