thyroid storm treatment

16 Dec
Treat symptoms with Beta blocker:
propranolol: also slows peripheral conversion of T4 to T3
–lesser options: esmolol, metoprolol, calcium channel blockers (diltiazem)
Inhibit thyroid hormone synthesis (works in 1-2 hrs):
–propylthiouracil (PTU): blocks thyroidal peroxidase, also inhibits T4 to T3 conversion
–lesser options: methimazole
Block release of thyroid hormone:
iodine: give ~1 hour AFTER other stuff, otherwise it’ll form MORE thyroid hormone
Steroids (thyroid storm can precipitate adrenal insufficiency, maybe autoimmune effects if Grave’s disease):
dexamethasone: also blocks T4 to T3 conversion
–other options: hydrocortisone
thyroid storm is not awesome
–treat symptoms, stop thyroid hormone synthesis, inhibit release, give steroids
–ideally: propranolol, PTU, waaaaaiiit an hour, iodine, dexamethasone
Reference(s): thyroid storm, Tintinalli p. 1312-3, picture

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