Critical Appraisal Of The Literature
We performed a literature review through Ovid MEDLINE and PubMed using the terms hyperthyroidism, thyrotoxicosis, thyroid storm, hypothyroidism, and myxedema. We then performed a manual search of the resulting articles to find further relevant articles. The Endocrine Society has published an excellent clinical management guideline for hyperthyroidism and hypothyroidism as well as for the pregnant and postpartum population, but this does not address emergent intervention.3 Recent meta-analyses and randomized control trials tend to focus on the ideal pharmacological, radiotherapeutic, or surgical regimens for long-term therapy of hyperthyroidism, all of which are of limited importance to the emergency clinician. A number of case reports and case reviews exist as well for the more esoteric presentations associated with thyroid disorders.
Aside from the relatively recent development of intravenous thyroxine, the management of myxedema and thyroid storm has changed little since the mid twentieth century. Perhaps the most relevant papers to the practicing emergency clinician are the focused clinical reviews available on subtopics within the thyroid disease literature, including neonates, children, the elderly, antithyroid drugs, and mechanical ventilation principles.
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