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Thyroid Storm — RACP Adult Medicine MCQ

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HardEndocrinologyThyroid StormRACP Adult Medicine

A 55-year-old with untreated Graves disease has fever 40°C, atrial fibrillation at 150/min, agitation, vomiting and heart failure. After a thionamide has been administered, which sequence is most appropriate as part of immediate multimodal thyroid-storm treatment?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Give inorganic iodine one hour after thionamide, plus titrated beta blockade and IV glucocorticoid

Explanation lettering: E = shown as B · D = shown as C · C = shown as D · B = shown as E

C is correct. Thyroid storm requires simultaneous supportive care and treatment of hormone synthesis, release and peripheral effects. The thionamide is given before iodine so new iodine is not used for hormone synthesis; iodine follows after at least an hour, while a beta blocker is used cautiously according to haemodynamics and glucocorticoid reduces peripheral conversion and covers relative adrenal insufficiency. D reverses the critical sequence. E adds thyroid hormone and provides inadequate adrenergic control. A has delayed effect and can initially worsen hormone release. B has no relevant antithyroid action. The choice of propylthiouracil versus carbimazole and propranolol versus a short-acting beta blocker depends on hepatic and cardiovascular circumstances.

Reference: Queensland Health: Primary Clinical Care Manual: https://www.health.qld.gov.au/__data/assets/pdf_file/0022/1447051/PCCM_full.pdf