Thyroid storm is tumultuous and exciting; Myxedema is somewhat enervating and markedly less exciting–but it is also life threatening. We need to know about this disease! Today, I interview Arti Bhan, MD on the topic:
Arti Bhan, MD
Division Head, Endocrinology @HenryFord Health System
“I strive to provide the highest quality health care services to all my patients efficiently, effectively and compassionately. I believe in partnering with my patient in order to achieve our goals.”
Dr. Bhan received her medical degree from India. She completed an Internal Medicine Residency at St. John Hospital and Medical Center and then went on to a fellowship in Endocrinology at Henry Ford Health System.
She has been a senior staff physician at Henry Ford since 2003 and is currently serving as the Division Head of Endocrinology. She is active in clinical research and is an investigator in numerous trials, including NIH funded studies. She is published in peer reviewed literature and is the Associate Editor for Clinical Diabetes.
Dr. Bhan's main area of interest is in thyroid disorders, and she trains fellows in thyroid ultrasonography and thyroid biopsies.
What We Cover on Myxedema
- What is the look of myxedema
- What TSH should get you worried
- How to treat Myxedema
- Should we use T3 (LT3)
- What do resus docs screw up when treating myxedema
Related & More
- IBCC Myxedema
- EMCrit Thyroid Storm
- EMCrit 292 IV T3 for Myxedema Coma, A Different Take with Eve Bloomgarden
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Professor
Nassau University Medical Center
No conflicts of interest (coi).
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One of our ED docs has recently added a FT4 without a TSH to the lab panel that he draws on delirious patients. I have found no support for this and argued that if they want to check anything, check a TSH with reflex T4 if the TSH is abnormal. Am I missing something? Enjoy the podcast
Secondary hypothyroidism can have a TSH that appears in normal range but will have low T4. TSH can also be slow to respond, for still unknown reasons, and if used alone can miss low T4. I’ve see patients with very low T4 and T3 and obvious hypothyroid symptoms still have a normal TSH, they improved with thyroid medication. Also, another patient with results showing hyperthyroidism with a TSH of 0.002 but severe clinical symptoms and history of hypothyroidism and temperature of 34C. They had an rT3 three times the normal limit indicating an excessively high deiodinase 3 (D3) enzyme level… Read more »
When we start treating it in the ED? Based on history and physical only is the possibility?