 Welcome back to emergency medicine video series on thyroid storm. This segment focuses on diagnosis and treatment in the emergency department. Please ensure you have reviewed part one already. How is thyroid storm diagnosed? It is diagnosed mostly clinically by signs and symptoms. Thyroid storm is tricky to diagnose. This heightened metabolic state shares the symptoms with a few other conditions that almost look about the same. Remember what these patients look like? They would have fever. In terms of the heart, they will have tachycardia, arrhythmia, CHF, Shaughness of Breath, and in terms of the CNS, they will be agitated, confused, psychotic, or have seizures. What conditions can you think of that look like this? There are three main broad categories. First of all, it's heat stroke. Often the history might be helpful. The second category is sepsis that can affect any part of the body. The last big categories are toxins, such as sympathomimetics, serotonin syndrome, or neuroleptic malignant syndrome. They can all kind of look like thyroid storm. If the history does not help you, sometimes laboratory studies might help us sort this out. What labs would be helpful? Specific to the thyroid, if this is a thyroid storm, or at least a hyperthyroid state, you expect a high T3, high T4, and a low TSH. Because of the effect of the thyroid storm on the body, we expect the patient to have a high CK, sometimes a high troponin even, and high LFTs. In a patient who has short of breath, or you think is in pulmonary edema, a chest x-ray is often helpful. Also, if the patient is in any tachyrethmia at all, a 12-lit ECG or rhythm stroke will be very helpful in sorting this out. Remember how thyroid storms usually triggered? Besides looking for a thyroid storm itself, we may still have to look for the trigger. Therefore, we may have to do labs such as CBC, electrolytes, BN, creatinine, and cultures. That might help you find the trigger. Remember these patients often have two diagnoses, the thyroid storm and the trigger itself. Both might need to be addressed at the same time. Let's talk about the different kind of treatment. Treatment is divided into four different components. First, we block the hormone from the thyroid gland. Second, we block the peripheral effects of the hormone. Thirdly, we give supportive care to the patient, ensuring the ABC is all right. And fourthly, we look for that trigger and we treat it. We'll now talk about each one of them. We first block the thyroid hormone production by the thyroid gland. We do this by giving a medication called P-T-U or propolythyrouricil. Another medication called methamazol can also be given. About an hour after this, we now also block the release of the hormone that's already made before by iodine loading the body. We do this in the form of LugoSolution or SSKI. The second part is to block the peripheral effects of the thyroid hormone. One, we treat the tachycardia by a beta blocker. The most often used is propanolol. Secondly, we try to inhibit the peripheral conversion of T4 to T3, since T3 is the active form. We do this by giving a dose of glucocorticoid steroids. In terms of supportive care, these are a usual ABC. We try to make sure the airways patent, and if we need to, we intubate the patient. If we want to understand oxygen, and in terms of circulation, we'll give IV fluids to support a low blood pressure. We treat fever by giving acetaminophen. We do not use aspirin in this case. For agitation and change in level of consciousness, we give benzodiazepine. This will also work for seizures as well. As we've discussed before, we also look for underlying trigger. We look for an infection, an underlying MI, or an occult trauma. In terms of disposition, all patients with thyroid storm needs to be admitted, usually in the ICU. This hypermetabolic state can have a lot of long-term sequelae and needs to be recognized and treated as soon as possible. In summary, we discuss the diagnosis and treatment of thyroid storm. Thank you for watching.