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Thyroid Storm Monitoring — RACP Adult Medicine MCQ

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ModerateEndocrinologyThyroid Storm MonitoringRACP Adult Medicine

A 40-year-old man with thyroid storm is treated with PTU, propranolol, Lugol iodine, and dexamethasone. After 4 hours, his HR decreases from 160 to 95 bpm and temperature from 40°C to 38.5°C. However, he remains delirious. What is the most important ongoing management?

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Correct answer: A — Continue current regimen and monitor in ICU

Initial clinical improvement (HR and temperature decreasing) after thyroid storm treatment indicates response to therapy. Continue current regimen and ICU monitoring. PTU takes 1-2 hours to begin blocking synthesis and 24-48 hours for clinical effect. If not improving after 24-48 hours of maximal medical therapy, consider: plasma exchange (or plasmapheresis) to remove circulating thyroid hormones, cholestyramine (binds T4 in gut), or emergency thyroidectomy (last resort).

Reference: eTG Endocrine – 2024 – Thyroid Storm; ATA 2016