We start this Wednesday’s Pharm and Cheese off with something unappetizing: emesis. You’re rounding on Red Team and meet a patient with a history of cholangiocarcinoma on chemotherapy who isn’t tolerating PO pending a CT scan. He has normal vitals and a benign exam, but he tells you that for the past two weeks he’s had intractable emesis, even when not eating or drinking. He initially thought it was just from chemo, but his last round was 3 weeks ago and he hasn’t improved. 

Samson Frendo MD and Eric Leser MD

There are no specific lab value parameters that differentiate thyroid storm from less severe thyrotoxicosis, but the presence of multiorgan dysfunction is key8. We have a great guideline for general thyrotoxicosis management (“Thyrotox Updated Guideline”) on the Intranet, so this Cheese is only a closer look at thyroid storm in particular. 

Nanditha Ravichandran MD, Joanne Routsolias PharmD, and Eric Leser MD