Dr Leonard Wartofsky is a professor of medicine at Georgetown University Hospital, chairman emeritus of the Department of Medicine at the Washington Hospital Center, and past president of the American Thyroid Association and the Endocrine Society.
Leonard Wartofsky, MD, MPH: Yes, definitely. Patients with thyroid emergencies, either thyrotoxic storm or myxedema coma, must be treated in an ICU, where they can be monitored closely with Swan-Ganz catheters or other mechanisms to closely follow blood pressure and respiratory function. They need periodic blood gases to make sure their ventilation is optimal. Electrolytes are important, particularly looking at the hyponatremia in the myxedema coma patient. And of course, keeping close track on temperature in both types of patients [is important] as well, and careful monitoring of the effects of various drugs that are being given.
There is really no substitute for the ICU for these patients.