Endocrinology

Question 1

Thyroid storm management

Answer 1

1. Propranolol (or esmolol if CHF or reactive airways)
2. Thionamide (PTU preferred over methimazole due to earlier onset & inhibits peripheral conversion of T4 to T3, but avoid in liver disease)
3. Potassium iodide (1 hour after thionamide; avoid if patient on amiodarone)
4. Glucocorticoid (hydrocortisone; blocks T4 to T3 and addresses associated adrenal insufficiency)
5. Bile acid sequestrant (cholestyramine; inhibits enterohepatic circulation of thyroid hormone)

Question 2

Addison disease pathophysiology, presentation & management

Answer 2

• pathophysiology: primary adrenal insufficiency –> decreased cortisol & aldosterone –> decreased sodium & glucose, increased potassium
• presentation: hypopigmentation, fever, N/V/D, abdominal pain, shock (adrenal crisis)
• management: supportive, hydrocortisone