THYROID STORM-MGM

SUMMARY

1. Manage relative adrenal insufficiency with glucocorticoids.

2. Interrupt the physiologic response to excess thyroid hormone: IV propranolol or esmolol.

3. Block new hormone synthesis: high-dose thionamide (PTU or MMI).

4. Block release of preformed hormone from the gland: stable iodide.

5. Block peripheral conversion of T₄ to T₃: iodinated contrast agent, propranolol, and corticosteroids. PTU also does this (but not MMI).

6. Give empiric broad-spectrum antimicrobial coverage until infection is excluded.

7. Provide supportive care in the ICU with diligent attention to volume status, temperature, and heart rate.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].