There have been numerous case reports of acute hemodynamic collapse after the administration of oral propranolol in patients with diagnosed thyroid storm.83 Although no specific mechanisms have been elucidated, it is presumed that these particular patients had an associated low output heart failure before the administration of beta-blockers. No prospective trials on the use of beta-blockers in patients with thyroid storm and concurrent low output heart failure exist. Therefore, one must be cautious when using intravenous, short-acting, titratable beta-blockers, such as esmolol, in these patients.
Widespread existence of nuclear power has drawn the attention of disaster specialists. Preparation for radiation emergencies sparks controversy. The current literature supports the use of a single oral dose of 38 mg iodide for thyroid stabilization in radiation emergencies.133
Recent recommendations support screening for hypothyroidism in all geriatric women who have respiratory distress, confusion, or hypothermia and all geriatric patients who are admitted to the hospital, as the incidence is high in these populations.50,55 This diagnosis may be outside the role of the emergency clinician.