Thyroid Storm

AUDIENCE: This is a practice oral boards case which may be given to emergency medicine (EM) residents at all levels of training and recent EM graduates. INTRODUCTION/BACKGROUND: Thyroid storm is an acute, life-threatening endocrine emergency. It occurs when there is excess circulating thyroid hormone in the bloodstream. It may be precipitated by infection, surgery, pregnancy, trauma, thyroid medication changes, or iodinated contrast exposure. This condition must be quickly identified and treated by EM physicians in order to prevent morbidity and mortality. IThe mortality rate is between 10 and 30%1 Understanding and treating thyroid storm is included in the 2019 Model of Clinical Practice of Emergency Medicine.2 EDUCATIONAL OBJECTIVES: At the end of this practice oral boards case, the learner will: 1) assess a patient with altered mental status in an oral boards format; 2) review appropriate laboratory testing and diagnostic imaging; 3) identify signs and symptoms of thyroid storm and 4) review appropriate pharmacologic therapies with the proper sequence and timing. EDUCATIONAL METHODS: Practice boards case. RESEARCH METHODS: This oral boards practice case was developed and then tested in several small group settings. First, EM resident learners discussed the case in a small group format. Their feedback was utilized to refine the case’s textual information. Subsequently, EM physicians preparing for the ABEM oral board examination provided additional general feedback of the case and completed an anonymous survey regarding case quality and educational value. RESULTS: Minor changes were made based on feedback from small group sessions. The finalized case was tested with individuals, and surveys showed that 92% (12/13) of individuals rated the case quality as excellent (standard Likert scale 1–5 with 5 being Excellent). All participants responded affirmatively that the case enhanced their understanding of thyroid storm. DISCUSSION: This oral boards practice case was effective in preparing learners for the ABEM oral boards exam. Based on learner feedback, several laboratory results were added to the stimulus package and wording was edited to improve the clarity of the case. TOPICS: Hyperthyroidism, thyrotoxicosis, thyroid storm, endocrine emergencies, altered mental status.