Thyroid and Parathyroid Endocrine Emergencies

Thyrotoxic storm and myxedema coma are uncommon, though important life-threatening endocrine emergencies that result from extreme hyperthyroidism and hypothyroidism, respectively, with multiorgan dysfunction. Rapid diagnosis and prompt adequate treatment are mandatory to prevent their deleterious consequences and fatal outcome. Therefore, it is important that surgeons understand the clinical presentation, pathophysiology, and appropriate treatment of these. Patients with both thyrotoxic storm and myxedema coma should be managed in an intensive care unit (ICU) with continuous electrocardiogram, arterial blood gas, and central venous pressure monitoring. In addition, bacterial infection should be sought and properly treated in both conditions. Parathyroid (hypercalcemic) crisis is a reversible, curable, but life threatening. If proper treatment is not initiated promptly, rapid progression ending in death may occur. Hypercalcemic crisis patients should be treated in the ICU. Emergency treatment is the same regardless of the cause and consists of early fluid replenishment and promotion of calciuresis with normal saline and loop diuretics. Bisphosphonates and calcitonin may be subsequently added. Hypoparathyroidism is most commonly caused by surgery for parathyroid disease, thyroid disease, or extensive head and neck cancers. Severe hypocalcemia resulting from any cause can be life threatening; therefore, establishing the appropriate diagnosis and initiating prompt therapy is critical. Close monitoring is indicated to determine if long-term therapy is necessary.