Thyroid Storm & Myxedema Coma: The Treatment Sequence That Saves Lives | EM Board Review

Thyroid storm and myxedema coma — the four-drug storm sequence (BB → thionamide → iodine → glucocorticoid), why iodine comes AFTER thionamide, Burch-Wartofsky scoring, and the critical rule of giving hydrocortisone BEFORE levothyroxine in myxedema coma. 📑 Chapters 0:00 Intro 0:03 Title 0:24 Objectives 1:04 ED Mindset Treat Before Labs 1:32 Thyroid Storm Recognition 2:21 Burch Wartofsky Scoring 3:03 Thyroid Storm Treatment Sequence 3:45 Beta Blockade in Storm 4:32 Thionamides PTU vs Methimazole 5:13 Iodine After Thionamide 5:55 Glucocorticoids in Storm 6:31 Supportive Care & Triggers 7:16 Myxedema Coma Recognition 8:04 Diagnostic Workup Myxedema 8:42 Steroids Before or With Levothyroxine 9:20 Thyroid Hormone Replacement Myxedema 9:58 Airway Considerations 10:24 Rewarming & Supportive Care 11:05 Hyponatremia in Myxedema 11:47 Disposition Both Conditions 12:12 Board Traps Thyroid 12:44 Case 1 Thyroid Storm with AFib 13:30 Case 2 Myxedema Coma 14:19 Board Question 1 14:38 Board Question 2 14:59 Board Question 3 15:19 Final Takeaways 15:55 References Presented by Ezekiel Shepard, M.D. Shepard MD — high-yield emergency medicine education for board exams, shift performance, and clinical reasoning. ⏱ CHAPTERS 0:00 Title 0:21 Objectives 1:01 ED Mindset Treat Before Labs 1:29 Thyroid Storm Recognition 2:18 Burch Wartofsky Scoring 3:00 Thyroid Storm Treatment Sequence 3:42 Beta Blockade in Storm 4:29 Thionamides PTU vs Methimazole 5:10 Iodine After Thionamide 5:52 Glucocorticoids in Storm 6:28 Supportive Care and Triggers 7:13 Myxedema Coma Recognition 8:01 Diagnostic Workup Myxedema 8:39 Steroids Before or With Levothyroxine 9:17 Thyroid Hormone Replacement Myxedema 9:55 Airway Considerations 10:21 Rewarming and Supportive Care 11:02 Hyponatremia in Myxedema 11:44 Disposition Both Conditions 12:09 Board Traps Thyroid 12:41 Case 1 Thyroid Storm with AFib 13:27 Case 2 Myxedema Coma 14:16 Board Question 1 14:35 Board Question 2 14:56 Board Question 3 15:16 Final Takeaways 15:52 References 📚 ABOUT THIS SERIES Shepard MD delivers polished, board-relevant emergency medicine lectures for residents, attendings, and students preparing for boards or trying to sharpen on-shift clinical reasoning. Each lecture covers a focused high-yield topic with specific dosing anchors, treatment-sequence framing, and the classic board traps. 🎓 REFERENCES & ACKNOWLEDGEMENTS Content informed by Rosen's Emergency Medicine (10th edition), Foundations of EM Board Review, and current society guidelines (ACEP, AHA/ACC, SCCM, IDSA, ATLS, and others as relevant per lecture). ⚠ DISCLAIMER This content is for educational purposes only. It does not replace clinical judgment, institutional protocols, or specialty consultation. Always follow your local guidelines and consult appropriate specialists. 💬 Comment with topics you want covered next. 👍 Like and subscribe for more high-yield emergency medicine board content. #EmergencyMedicine #BoardReview #MedicalEducation #ShepardEMBoardReview