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Thyroid Storm — RACP Adult Medicine MCQ

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HardEmergency MedicineThyroid StormRACP Adult Medicine

A 35-year-old woman presents with a thyroid storm precipitated by non-compliance with carbimazole. She has fever (40°C), tachycardia (HR 150 bpm), agitation, and jaundice. What is the correct sequence of acute pharmacological management?

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Correct answer: A — Propranolol → propylthiouracil → Lugol's iodine → hydrocortisone

Thyroid storm management follows a specific sequence: (1) Beta-blocker (propranolol – also inhibits T4→T3 conversion) to control sympathetic symptoms; (2) Thionamide (PTU preferred as it also inhibits peripheral T4→T3 conversion); (3) Iodine solution (Lugol's or potassium iodide) given at least 1 hour AFTER thionamide to prevent using the iodine as substrate for new hormone synthesis (Wolff-Chaikoff effect); (4) Hydrocortisone 100 mg IV 8-hourly (reduces T4→T3 conversion and treats relative adrenal insufficiency).

Reference: eTG – 2025 – Endocrinology; ATA – 2016 – Thyroid Storm Guidelines