thyroid storm treatment

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

10-SECOND RECAP:

--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): uptodate.com: thyroid storm, Tintinalli p. 1312-3, picture