Thyroid storm
- ICU emergency: treat before labs normalize
- Beta blocker controls adrenergic excess
- PTU or methimazole blocks hormone synthesis
- Give iodine AFTER thionamide
- Glucocorticoid ↓ T4→T3 + treats adrenal stress
- Support cooling/fluids + treat trigger
- Consider cholestyramine in severe cases
Use at a glance
- ICU emergency: treat before labs normalize
Practical pearls
- Beta blocker controls adrenergic excess
- PTU or methimazole blocks hormone synthesis
- Give iodine AFTER thionamide
Escalation / refractory disease
- Glucocorticoid ↓ T4→T3 + treats adrenal stress
- Consider cholestyramine in severe cases
Other practical pearls
- Support cooling/fluids + treat trigger
Self-check
- In thyroid storm, should iodine be given before or after a thionamide?
After.
- What controls adrenergic excess in thyroid storm?
A beta blocker.
- Why are glucocorticoids used in thyroid storm?
They reduce T4→T3 conversion and support adrenal stress.
Drugs used for this (4)
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