Management of patients with thyroid emergencies in the ICU

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.

Should patients with thyroid emergencies (myxedema coma, thyroid storm) be treated in the intensive care unit (ICU)? What parameters and laboratory tests should be monitored?

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.