Management of Thyroid Storm

• Supportive Measures:
o Cooling blanket and tylenol; avoid aspirin
o Benzodiazepines for agitation
o Fluid as there are a lot of insensible losses; dextrose fluid for low glucose
o Treat underlying trigger
o Afib often converts on it’s own with thyroid storm medical management

• Medical Management:
o Propranolol → titrate to HR of 90-100; half life is 5 minutes
      Decreases sympathetic hyperactivity
      Partially blocks T4 → T3 conversion
o Thionamides
      Blocks thyroid hormone synthesis and T4 → T3 conversion
      PTU preferred because faster onset and safer in pregnancy
      PTU with black box warning for hepatotoxicity
      PO medication so may need NGT or give rectally

o Iodide → must be given 1 hour after Thionamides because Jod-Basedow phenomenon will worsen thyroid storm
      Can use SSKI or Lugol’s solution
      Li to be used if there is an Iodide allergy

o Steroids → Decrease T4 → T3 conversion and treats accompanying adrenal insufficiency.

Reference: M. Chansky, M.D., 'Endocrine Emergencies', Cooper University Hospital, Dept of EM.  February 2018.