Key Points
- Stabilize ABCs; begin targeted evaluation without delaying life-saving therapy.
- Use system-specific risk tools to guide testing and disposition.
- Order high-yield tests first; escalate imaging when indicated.
- Start evidence-based initial therapy and reassess frequently.
Algorithm
- Primary survey and vitals; IV access and monitors.
- Focused history/physical; identify red flags and likely etiologies.
- Order system-appropriate labs and imaging (see Investigations).
- Initiate guideline-based empiric therapy (see Pharmacology).
- Reassess response; arrange consultation and definitive management.
Clinical Synopsis & Reasoning
For Graves Disease Antithyroid Drugs Rai And Surgery, frame the differential by acuity and pathophysiology, then align diagnostics to the leading hypotheses. Prioritize stabilization while obtaining high‑yield studies such as BMP (Electrolytes/anion gap), Ketones (if DKA) (Ketoacidosis), ABG/VBG (Acid–base status). Incorporate bedside imaging and targeted labs to define severity and identify complications; synthesize results with clinical trajectory to refine the working diagnosis and disposition needs.
Treatment Strategy & Disposition
Initiate disease‑directed therapy alongside supportive care, titrating to objective response. Pharmacologic options commonly include Insulin, Dextrose, Electrolytes (K+, Mg2+). Use validated frameworks (e.g., Antithyroid Drugs — Key Points) to guide escalation and site of care. Address precipitating factors, de‑escalate empiric therapies with data, and arrange follow‑up for monitoring and risk‑factor modification; admit patients with instability, high risk of deterioration, or needs for close monitoring.
Epidemiology / Risk Factors
- Diabetes and endocrine disorders depending on topic
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| BMP | Electrolytes/anion gap | Derangements | |
| Ketones (if DKA) | Ketoacidosis | Positive | |
| ABG/VBG | Acid–base status | Acidosis/alkalosis |
Antithyroid Drugs — Key Points
| Drug | Initial Dose | Adverse Effects |
|---|---|---|
| Methimazole | 10–30 mg daily | Agranulocytosis, cholestasis |
| Propylthiouracil | 50–150 mg TID | Severe hepatotoxicity; use in 1st trimester |
| Beta‑blocker | Propranolol | Symptom control |
| RAI | I‑131 | Hypothyroidism common post‑therapy |
| Surgery | Total/subtotal thyroidectomy | Hypocalcemia, RLN injury |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Acetaminophen | Analgesic/antipyretic | Hours | Symptom control as appropriate | Hepatotoxicity (overdose) |
| Ondansetron | 5-HT3 antagonism | Minutes | Antiemesis if needed | QT prolongation |
Prognosis / Complications
- Improves with derangement correction; recurrence if triggers persist
Patient Education / Counseling
- Explain red flags and when to seek emergent care.
- Reinforce medication adherence and follow-up plan.
Clinical Notes
Discuss pregnancy plans. Provide radiation precautions for RAI. For active moderate‑severe orbitopathy, prefer ATD or surgery; if RAI used, give steroids.
References
- ATA Hyperthyroidism Guideline — Link