ENDOCRINE

ResponseHyperthermia/Fever
Tachycardia disproportionate to fever
CNS disturbance

ResponseDDx Hot and confused:
Thyroid storm
Phaeocrhomocytoma
Heat related illness
Intracranial SOL/lesion - hypothalamic stroke
Sepsis - meningioencephalitis/other
Drugs

• Toxidrome - sympathomimetic/anticholinergic/serotonin syndrome/NMS
• Withdrawal - EtOH, Benzos

ResponseSepsis
MI
DKA
Trauma/Surgery
IV contrast
Unrecognised/undetreated/non compliance with medications
Ingestion of thyroid hormone
Withdrawal of thyroid medications

ResponseControl tachycardia with beta blocker (ie: block peripheral effects)

• Propraolol 40-80 mg QID
• Escilate to Esmolol 250-500 mics loading >> 50/100 mics/kg/min infusion OR IV metoprolol 5mg Q5 min to 15 mg if fails

Antithyroid treatment
Decrease synthesis of thyroid hormone

• Propylthiouracil 200 mg PO Q4-6h (some ans say loading dose 900-1200mg)
• OR carbimazole 20 mg PO Q6-8h

Reduce release of thyroid hormone

• “lugol solution” - 5% iodine + potassium iodine 10% in water - 0.5mL PO TDS. give AFTER PTU not before

Reduce conversion of T4-T3 with

• Dexamethasone 4mg (IV/PO) Q12H

eTG april ‘24

ResponseCooling - cooling blankets, antipyretics, cool fluids
Fluid resuscitation/ABC’s
Seek and treat precipitants - Eg: ECG ? ACS, cultures/IVABx ? sepsis
Seek and treat complications Eg: CVS collapse
Avoid NSAID’s (Displace T4 from binding proteins)
Endocrine admission
HDU bed