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Pathophysiology and management of thyroid disorders in the critically ill 

Pathophysiology and management of thyroid disorders in the critically ill
Pathophysiology and management of thyroid disorders in the critically ill

Michael O’Dwyer

and David Watson

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date: 05 July 2022

Although overt thyroid disease as a primary admission diagnosis to an intensive care unit is uncommon, failure to recognize and adequately manage this condition can have fatal consequences. Hyperthyroidism is usually manifested by signs and symptoms of an exaggerated sympathomimetic response. In its most severe forms, a thyroid storm will necessitate a multimodal treatment. Although robust evidence is lacking, radiographic contrast dyes containing iodine are becoming popular as a first-line treatment. Hypothyroidism can similarly present as a diagnostic dilemma, particularly in the elderly. Management is difficult with little consensus as to the optimal pharmacological approach. Treatment should be individually tailored, while remaining vigilant for the unwanted side effect of treatment with thyroid hormones. In contrast, sick euthyroid syndrome is commonly observed in the critically ill. A sound understanding of the action of thyroid hormones in health and in the critically ill will benefit clinicians in recognizing these disorders and also in guiding their management in an area where significant variability remains in therapeutic approaches.

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