A 25 y/o female presents to your emergency department with heart palpitations for past 4 days.  Her vital signs are blood pressure of 180/90, heart rate of 120 beats per minute, respiratory rate of 22 breaths per minute, and temperature of 102°F.  After thorough examination and workup you make the diagnosis of thyroid storm.  What is the correct sequence of medications to treat thyroid storm?  (scroll down for the answer) 

A) Propranolol, Methimazole, Potassium Iodide, Hydrocortisone 

B) Potassium Iodide, Methimazole, Propranolol, Hydrocortisone

C) Hydrocortisone, Potassium Iodide, Propranolol, Methimazole

D) Propranolol, Potassium Iodide, Methimazole, Hydrocortisone 

The correct answer is A) Propranolol, Methimazole, Potassium Iodide, Hydrocortisone. 

The correct sequence of medications used to treat thyroid storm is first propranolol, second methimazole, third potassium iodide, fourth hydrocortisone.

Steps of Thyroid Storm Treatment

1) Stabilization

2) Beta Blockade 

- Propranolol most commonly used 

3) Inhibition of new thyroid hormone synthesis with thionamides 

- Methimazole or Propylthiouriacil 

- Avoid methimazole for pregnant women in first trimester 

- Propylthiouriacil also blocks peripheral conversion of thyroxin to triiodothyronine 

4) Inhibition of thyroid hormone release (at least 1 hour after step 3)

- Potassium iodide (SSKI) or Lugol solution 

5) Preventing peripheral conversion of T4 to T3

- Hydrocortisone

Click here for more on thyroid storm: http://emdaily.cooperhealth.org/content/emconf-thyroid-storm-treatment