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Thyroid Storm Antipyresis — RACP Adult Medicine MCQ

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ModerateEmergency MedicineThyroid Storm AntipyresisRACP Adult Medicine

A 40-year-old woman with Grave's disease develops acute thyrotoxic crisis (thyroid storm) with fever 41°C, HR 160, AF with rapid ventricular rate, and confusion. She is commenced on IV propranolol, PTU, Lugol's iodine (after PTU), and hydrocortisone. Despite treatment, her temperature remains critically elevated. What additional cooling measure is appropriate?

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Correct answer: E — Dantrolene

In thyroid storm, aspirin should be AVOIDED for antipyresis because it displaces thyroid hormones from TBG (thyroid-binding globulin), paradoxically increasing free T3/T4 levels and worsening the crisis. Paracetamol is the preferred antipyretic. Active cooling measures (cooling blankets, ice packs to groin/axillae, tepid sponging) should be employed for refractory hyperthermia. Dantrolene is reserved for malignant hyperthermia (a different condition). The Burch-Wartofsky score >45 confirms thyroid storm. Cholestyramine (binds thyroid hormones in the GI tract) can be added as an adjunct in refractory cases.

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