Case Introduction

You are working a shift at EM Clerkshift General when a sepsis alert is paged overhead for a young female  who appears diaphoretic and confused.

Initial Vitals

  • Temp 102.7F
  • HR 145
  • RR 32
  • BP 141/85
  • O2 93%

Critical Actions

  • Workup and treat for sepsis upfront (Cultures, Lactate, IVF, Abx)
  • Order TSH with Free T4
  • Administer non-selective Beta Blocker (Propanolol)
  • Administer Inhibitor of Thyroid Hormone Synthesis (Methimazole or PTU)
  • Administer Steroids, +/- Iodine (must be given after inhibitor)

Final Diagnosis

Post Partum Thyroid Storm

Tips and Tricks

  • Be aware of common post-partum pathologies (PP depression, hyper/hypothyroidism, cardiomyopathy, infections, eclampsia, etc)
  • Have a DDX for Fever other than infectious (especially if refractory to acetaminophen)
  • Administer treatment in correct order (BB first, inhibitor second, Iodine at least 1 hour after inhibitor, steroids)

Further Reading

Thyroid Storm (EMCrit)