Thyroid Storm — RACP Adult Medicine MCQ
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Correct answer: D — Give a thionamide, then iodine; add haemodynamically tolerated beta blockade, corticosteroid and supportive treatment of infection
The best answer is “Give a thionamide, then iodine; add haemodynamically tolerated beta blockade, corticosteroid and supportive treatment of infection”. Thyroid storm is a clinical emergency requiring simultaneous control of hormone synthesis, release and peripheral effects plus supportive treatment of the precipitant. Iodine follows the thionamide so it cannot provide substrate for new synthesis; corticosteroid reduces peripheral conversion and covers relative adrenal insufficiency. Beta blockade is tailored to haemodynamics, particularly when heart failure is possible. Radioiodine acts too slowly.
Reference: Queensland Health: Hyperthyroidism clinical prioritisation criteria: https://www.health.qld.gov.au/cpc/diabetes-and-endocrinology/hyperthyroidism