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Thyroid storm — MCCQE Part 1 MCQ

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HardThyroid DisordersThyroid stormMCCQE Part 1

A 31-year-old woman with untreated Graves disease has fever, agitation, vomiting, atrial fibrillation at 170/min and diffuse goitre. Which of the following is the most appropriate next step?

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Correct answer: A — Start beta-blockade, thionamide, iodine after thionamide, corticosteroids and supportive care

Start beta-blockade, thionamide, iodine after thionamide, corticosteroids and supportive care is the single best answer because the age, timing, examination findings and investigations in the vignette fit Thyroid storm better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Canadian thyroid disease guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: Canadian thyroid disease guidance