A 52 year old man is brought in by EMS with complaints of altered mental status.
Family says that he has been recently feeling palpitations and diaphoresis and collapsed in his chair today.
On further questioning you gather that the patient has always been very skinny, anxious and sweaty. He recently went to his homeopath/shaman who gave him an old Inuit remedy called Illitsuitok. You look at the label (in Inuit) and see that the major ingredient is Iodine.
In the ED he is febrile to 102.9F, comatose and diaphoretic. He has lower extremity edema and his pants are full of diarrhea. His EKG shows Afib with RVR.
What is the most likely endocrinological emergency?
Thyroid storm
What tool can you use in order to classify or diagnose this entity?
Burch & Wartofsky diagnostic criteria: Temperature, Central nervous system dysfunction, Gastrointestinal dysfunction, Cardiovascular dysfunction, Heart failure and Precipitant History
What is the treatment?
Beta blockers (propranolol – high dose), PTU (not methimozole) and ABC’s of course
Written by Dr. Itamar Goldstein
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Itamar
Resident in the combined Emergency and Internal Medicine program at Kings County Hospital and SUNY Downstate Medical Centers.
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