This is an interesting overview of the management of thyrotoxicosis. I would be interested to hear the authors' advice for acute medicine physicians when encountering patients with overt hyperthyroidism in the Acute Medical Unit. I see 2 or 3 cases per year of patients presenting with symptoms such as palpitations, tremor or new atrial fibrillation, whose blood tests reveal complete suppression of circulating TSH. In the absence of on-site endocrinologists, we often have to instigate initial treatment ourselves. When endocrine advice is sought on the phone, the variation is usually enormous and confusing. Some recommend starting carbimazole outright, some recommend starting only beta-blockers for symptom control, then referring the patient for out-patient radionuclide scanning, whereas some recommend doing nothing, merely repeating the tests in a fe weeks time (not an attractive option for the patient).
We would greatly appreciate some guidance in the management of newly diagnosed, hospitalised, symptomatic patients with thyrotoxicosis.
Rapid Response:
This is an interesting overview of the management of thyrotoxicosis. I would be interested to hear the authors' advice for acute medicine physicians when encountering patients with overt hyperthyroidism in the Acute Medical Unit. I see 2 or 3 cases per year of patients presenting with symptoms such as palpitations, tremor or new atrial fibrillation, whose blood tests reveal complete suppression of circulating TSH. In the absence of on-site endocrinologists, we often have to instigate initial treatment ourselves. When endocrine advice is sought on the phone, the variation is usually enormous and confusing. Some recommend starting carbimazole outright, some recommend starting only beta-blockers for symptom control, then referring the patient for out-patient radionuclide scanning, whereas some recommend doing nothing, merely repeating the tests in a fe weeks time (not an attractive option for the patient).
We would greatly appreciate some guidance in the management of newly diagnosed, hospitalised, symptomatic patients with thyrotoxicosis.
Yours sincerely
Ben Lovell
Competing interests: No competing interests