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Thyroid storm — MCCQE Part 1 MCQ

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HardPalpitationsThyroid stormMCCQE Part 1

A 34-year-old woman with untreated Graves disease presents with fever, agitation, atrial fibrillation, vomiting and heart failure. She is febrile at 40.1°C and has a diffuse goitre. Which of the following is the most appropriate next step?

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

Thyroid storm is a life-threatening hyperthyroid emergency requiring multi-pronged therapy and supportive care. Iodine should be given after thionamide to avoid providing substrate for new hormone synthesis. Ultrasound, levothyroxine and beta-blocker monotherapy are inadequate for systemic decompensation.

Reference: Canadian endocrinology emergency practice; ATA guideline used in Canadian practice