So welcome back to the Internet Book of Critical Care podcast.

I'm here with Adam Thomas and we're going to talk about thyroid storm.

It's storm and where you are, the eastern seaboard having a rough going there, eh?

You got one of those north-easterns going on right now on the east coast?

This sounds pretty...

It's terrible.

I think we need to answer for Prinaloa.

You're just poking the bear right away.

Alright guys, today we're going to talk about that thyroid toxicosis and the thyroid storm.

We'll talk about your approach to diagnosis, the criteria that's controversial, of course management,

and then some highlights for refractory

thyroid storm and what you're going to do about it. So Josh, let's open that up, approach to

diagnosis. This is a tough diagnosis because it's going to mimic things which are super common

and it's just hard to always think about this. So I think we'd probably do pretty well if we

could try to always think about thyroid storm in the following situations. And I'll have to admit that I'm not good

at this, but maybe we can all work on being better at it. Number one, the patient with known

hyperthyroidism gets sick. I think that's probably the easiest one to remember. Number two,

folks with really bad atrial fibrillation, cardiomyopathy, you can't slow them down, their heart's just really not working well. Number three, nuance at delirum psychosis, especially with fever. And obviously, this is going to be

meningitis mimic hyperthermia. And lastly, kind of sepsis without an unclear source.

Josh has got a great image from the Indian Journal of Endocrine Metabolism that shows some

common physical presentations of thyroidyrotoxicosis that

would be associated with thyroid storm. But in general, when we talk about the precipitance

...