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Papi G, Corsello SM, Pontecorvi A. Clinical concepts on thyroid emergencies. Front Endocrinol (Lausanne). 2014;5:102doi: 10.3389/fendo.2014.00102.
Papi, G., Corsello, S. M., & Pontecorvi, A. (2014). Clinical concepts on thyroid emergencies. Frontiers in endocrinology, 5102. https://doi.org/10.3389/fendo.2014.00102
Papi, Giampaolo, et al. "Clinical concepts on thyroid emergencies." Frontiers in endocrinology vol. 5 (2014): 102. doi: https://doi.org/10.3389/fendo.2014.00102
Papi G, Corsello SM, Pontecorvi A. Clinical concepts on thyroid emergencies. Front Endocrinol (Lausanne). 2014 Jul 01;5:102. doi: 10.3389/fendo.2014.00102. eCollection 2014. PMID: 25071718; PMCID: PMC4076793.
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Front Endocrinol (Lausanne). 2014 Jul 01;5:102. doi: 10.3389/fendo.2014.00102. eCollection 2014.

Clinical concepts on thyroid emergencies.

Frontiers in endocrinology

Giampaolo Papi, Salvatore Maria Corsello, Alfredo Pontecorvi

Affiliations

  1. Department of Endocrinology, Catholic University of Rome , Rome , Italy.

PMID: 25071718 PMCID: PMC4076793 DOI: 10.3389/fendo.2014.00102

Abstract

OBJECTIVE: Thyroid-related emergencies are caused by overt dysfunction of the gland which are so severe that require admission to intensive care units (ICU) frequently. Nonetheless, in the ICU setting, it is crucial to differentiate patients with non-thyroidal illness and alterations in thyroid function tests from those with intrinsic thyroid disease. This review presents and discusses the main etiopathogenetical and clinical aspects of hypothyroid coma (HC) and thyrotoxic storm (TS), including therapeutic strategy flow-charts. Furthermore, a special chapter is dedicated to the approach to massive goiter, which represents a surgical thyroid emergency.

DATA SOURCE: We searched the electronic MEDLINE database on September 2013. Data Selection and Data Extraction: Reviews, original articles, and case reports on "myxedematous coma," "HC," "thyroid storm," "TS," "massive goiter," "huge goiter," "prevalence," "etiology," "diagnosis," "therapy," and "prognosis" were selected.

DATA SYNTHESIS AND CONCLUSION: Severe excess or defect of thyroid hormone is rare conditions, which jeopardize the life of patients in most cases. Both HC and TS are triggered by precipitating factors, which occur in patients with severe hypothyroidism or thyrotoxicosis, respectively. The pillars of HC therapy are high-dose l-thyroxine and/or tri-iodothyroinine; i.v. glucocorticoids; treatment of hydro-electrolyte imbalance (mainly, hyponatraemia); treatment of hypothermia; often, endotracheal intubation and assisted mechanic ventilation are needed. Therapy of TS is based on beta-blockers, thyrostatics, and i.v. glucocorticoids; eventually, high-dose of iodide compounds or lithium carbonate may be of benefit. Surgery represents the gold standard treatment in patients with euthyroid massive nodular goiter, although new techniques - e.g., percutaneous laser ablation - are helpful in subjects at high surgical risk or refusing operation.

Keywords: hyperthyroidism; hypothyroid coma; hypothyroidism; massive goiter; thyrotoxic storm; thyrotoxicosis

References

  1. J Clin Endocrinol Metab. 2007 Sep;92(9):3531-4 - PubMed
  2. Crit Care Med. 1992 Feb;20(2):276-91 - PubMed
  3. J Clin Endocrinol Metab. 2001 Aug;86(8):3579-94 - PubMed
  4. AACN Adv Crit Care. 2013 Jul-Sep;24(3):325-32 - PubMed
  5. Thyroid. 2002 Oct;12(10):897-902 - PubMed
  6. Chest. 2000 Sep;118(3):877-9 - PubMed
  7. J Emerg Med. 2012 Jan;42(1):e7-9 - PubMed
  8. Int Surg. 2008 May-Jun;93(3):158-62 - PubMed
  9. Eur J Cardiothorac Surg. 2003 May;23(5):840 - PubMed
  10. Curr Opin Endocrinol Diabetes Obes. 2008 Oct;15(5):434-9 - PubMed
  11. Resuscitation. 2006 Aug;70(2):287-90 - PubMed
  12. Emerg Med Clin North Am. 2005 Aug;23(3):669-85, viii - PubMed
  13. Am J Med. 2005 Apr;118(4):349-61 - PubMed
  14. Arch Intern Med. 1964 Jan;113:89-96 - PubMed
  15. J Formos Med Assoc. 2009 Apr;108(4):337-43 - PubMed
  16. Thyroid. 2010 Mar;20(3):333-6 - PubMed
  17. Med Clin North Am. 2012 Mar;96(2):385-403 - PubMed
  18. Cardiovasc Pathol. 2009 May-Jun;18(3):183-6 - PubMed
  19. Ann Endocrinol (Paris). 2007 Sep;68(4):224-8 - PubMed
  20. Eur Rev Med Pharmacol Sci. 2005 Jan-Feb;9(1):69-74 - PubMed
  21. Curr Opin Endocrinol Diabetes Obes. 2007 Jun;14(3):197-208 - PubMed
  22. J Clin Oncol. 2010 Apr 1;28(10):e151-4 - PubMed
  23. J Emerg Med. 2005 Feb;28(2):201-9 - PubMed
  24. Thyroid. 2008 Apr;18(4):479-81 - PubMed
  25. Pharmacotherapy. 2010 Apr;30(4):134e-8e - PubMed
  26. Indian Heart J. 2009 Jul-Aug;61(4):392-3 - PubMed
  27. Am J Med. 1978 Apr;64(4):613-21 - PubMed
  28. South Med J. 2002 May;95(5):552-4 - PubMed
  29. Clin Endocrinol (Oxf). 2007 Apr;66(4):565-71 - PubMed
  30. Otolaryngol Clin North Am. 1990 Jun;23(3):391-401 - PubMed
  31. Haemophilia. 2008 May;14(3):423-33 - PubMed
  32. Nat Rev Endocrinol. 2010 May;6(5):270-7 - PubMed
  33. Curr Drug Targets. 2009 Aug;10(8):778-87 - PubMed
  34. South Med J. 2009 Feb;102(2):193-5 - PubMed
  35. Arch Intern Med. 1969 Dec;124(6):684-90 - PubMed
  36. Thyroid. 2010 Jul;20(7):763-70 - PubMed
  37. Ann Endocrinol (Paris). 1964 Jan-Feb;25:103-6 - PubMed
  38. Ann Pharmacother. 2009 Dec;43(12):2113-6 - PubMed
  39. Anaesth Intensive Care. 2009 Nov;37(6):1005-7 - PubMed
  40. Endocr J. 2009;56(6):747-52 - PubMed
  41. Nucl Med Rev Cent East Eur. 2009;12(1):23-9 - PubMed
  42. Thyroid. 2007 Mar;17(3):283 - PubMed
  43. Eur J Intern Med. 2009 Oct;20(6):e136-7 - PubMed
  44. Baillieres Clin Endocrinol Metab. 1992 Jan;6(1):77-93 - PubMed
  45. Best Pract Res Clin Endocrinol Metab. 2009 Dec;23(6):723-33 - PubMed
  46. Baillieres Clin Endocrinol Metab. 1992 Jan;6(1):167-91 - PubMed
  47. Am J Med. 1971 Jul;51(1):41-53 - PubMed
  48. Ann Ital Med Int. 1991 Apr-Jun;6(2):248-50 - PubMed
  49. Acta Obstet Gynecol Scand. 2004 Nov;83(11):1089-91 - PubMed
  50. Thyroid. 2007 Jan;17(1):73-6 - PubMed
  51. Med Clin North Am. 1991 Jan;75(1):179-93 - PubMed
  52. N Engl J Med. 2010 May 20;362(20):1945-6 - PubMed
  53. Am J Med Sci. 2010 Aug;340(2):147-53 - PubMed
  54. Int J Legal Med. 2010 Nov;124(6):637-40 - PubMed
  55. AACN Clin Issues Crit Care Nurs. 1992 May;3(2):300-8 - PubMed
  56. Aging Clin Exp Res. 2004 Dec;16(6):490-4 - PubMed
  57. QJM. 2009 Mar;102(3):217-9 - PubMed
  58. J Neurosci Nurs. 2007 Feb;39(1):40-2, 57 - PubMed
  59. J Endocrinol Invest. 2003 Dec;26(12):1163-70 - PubMed
  60. Thyroid. 2007 Mar;17(3):229-35 - PubMed
  61. Adv Neurol. 1978;19:619-36 - PubMed
  62. J Obstet Gynaecol. 2007 Feb;27(2):213-4 - PubMed
  63. Am Surg. 2007 Dec;73(12):1247-9 - PubMed
  64. Med Clin North Am. 1995 Jan;79(1):169-84 - PubMed
  65. Clin Endocrinol (Oxf). 1994 Dec;41(6):731-7 - PubMed
  66. Postgrad Med J. 1988 Mar;64(749):209-12 - PubMed
  67. Ear Nose Throat J. 2002 Aug;81(8):570-2, 574 - PubMed
  68. Endocrinol Metab Clin North Am. 1993 Jun;22(2):263-77 - PubMed
  69. Artif Organs. 2010 Feb;34(2):E55-8 - PubMed
  70. Endocr Rev. 2011 Oct;32(5):670-93 - PubMed
  71. Thyroid. 2006 Aug;16(8):795-9 - PubMed
  72. Ann Nucl Med. 2006 Jul;20(6):383-5 - PubMed
  73. Intern Med. 2005 Mar;44(3):234-9 - PubMed
  74. Am J Clin Pathol. 2004 Jun;121 Suppl:S50-63 - PubMed
  75. Thyroid. 2012 Jul;22(7):661-79 - PubMed
  76. Rev Endocr Metab Disord. 2003 May;4(2):129-36 - PubMed
  77. Clin Nucl Med. 1996 Nov;21(11):905-6 - PubMed
  78. Obstet Gynecol Surv. 2006 Aug;61(8):535-42 - PubMed
  79. Clin Lab Sci. 2004 Fall;17(4):203-8 - PubMed
  80. Crit Care Clin. 2001 Jan;17(1):59-74 - PubMed
  81. J Clin Endocrinol Metab. 1997 Feb;82(2):329-34 - PubMed
  82. J Neurol Neurosurg Psychiatry. 1990 Jun;53(6):517-8 - PubMed
  83. Metabolism. 2000 Jun;49(6):753-4 - PubMed
  84. Thyroid. 2004 Aug;14(8):635 - PubMed
  85. J Clin Oncol. 2013 Jun 1;31(16):e262-4 - PubMed
  86. J Clin Endocrinol Metab. 2010 Jun;95(6):2529-35 - PubMed
  87. Endocrinology. 1987 Dec;121(6):2145-52 - PubMed
  88. South Med J. 2009 Feb;102(2):132 - PubMed
  89. Endocrinol Metab Clin North Am. 2006 Dec;35(4):663-86, vii - PubMed
  90. Ren Fail. 2011;33(5):553-4 - PubMed
  91. Endocr Pract. 2007 Sep;13(5):476-80 - PubMed
  92. J Endocrinol. 2005 Oct;187(1):1-15 - PubMed
  93. J Trauma. 2007 Sep;63(3):E85-7 - PubMed
  94. Am Surg. 1994 Aug;60(8):586-91 - PubMed
  95. Asian Cardiovasc Thorac Ann. 2003 Jun;11(2):165-6 - PubMed
  96. Pediatrics. 2010 Aug;126(2):e470-3 - PubMed
  97. Head Neck. 1994 Jan-Feb;16(1):72-4 - PubMed
  98. Acta Anaesthesiol Sin. 2002 Jun;40(2):71-9 - PubMed
  99. J Clin Psychiatry. 1984 Apr;45(4):188-9 - PubMed
  100. Endocr Rev. 2008 Feb;29(1):76-131 - PubMed
  101. Am J Med Sci. 2007 Nov;334(5):399-401 - PubMed
  102. Endocrinol Metab Clin North Am. 2008 Jun;37(2):525-38, xi - PubMed
  103. Crit Care Nurse. 2004 Apr;24(2):74-9 - PubMed
  104. J Clin Endocrinol Metab. 2001 May;86(5):1865-7 - PubMed
  105. Oncologist. 2009 Mar;14(3):233-9 - PubMed
  106. Emerg Med (Fremantle). 2001 Mar;13(1):116-20 - PubMed
  107. Am J Med. 2003 Oct 1;115(5):417-8 - PubMed
  108. Am J Med. 1983 Aug;75(2):353-9 - PubMed
  109. Am J Surg. 1989 Oct;158(4):378-80; discussion 380-1 - PubMed
  110. Br J Hosp Med (Lond). 2006 Sep;67(9):492-3 - PubMed
  111. Thyroid. 2006 Jun;16(6):621-2 - PubMed
  112. Surg Today. 1992;22(1):88-90 - PubMed
  113. Postgrad Med J. 2007 Feb;83(976):79-86 - PubMed
  114. Annu Rev Med. 1966;17:123-32 - PubMed
  115. J Clin Gastroenterol. 1999 Dec;29(4):318-21 - PubMed
  116. Nuklearmedizin. 2008;47(4):N44-6 - PubMed
  117. Curr Ther Endocrinol Metab. 1997;6:81-5 - PubMed
  118. Endocrinol Metab Clin North Am. 2007 Sep;36(3):707-35, vi - PubMed
  119. Injury. 2003 Dec;34(12):946-7 - PubMed
  120. Cah Coll Med Hop Paris. 1964 Apr;5:215-20 - PubMed
  121. Hormones (Athens). 2011 Apr-Jun;10(2):117-24 - PubMed
  122. Emerg Med Clin North Am. 1989 Nov;7(4):885-902 - PubMed
  123. Paediatr Anaesth. 2009 Apr;19(4):422-3 - PubMed
  124. Clin Nucl Med. 2003 Feb;28(2):138-9 - PubMed

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