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Thyroid storm — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesThyroid stormSCE Acute Medicine

An older patient has hypothermia, bradycardia, hypoventilation, hyponatraemia and reduced consciousness with free T4 profoundly low and TSH high. What is the immediate treatment?

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Correct answer: D — Give intravenous levothyroxine and hydrocortisone with organ support

The best answer is “Give intravenous levothyroxine and hydrocortisone with organ support”. This is correct because myxoedema coma combines severe hypothyroidism with decompensated organ function and high mortality. Stress-dose glucocorticoid is given until coexisting adrenal insufficiency is excluded. Passive rewarming, careful sodium and ventilatory management are required; outpatient oral therapy and antithyroid drugs are inappropriate.

Reference: Society for Endocrinology emergency guidance: myxoedema coma: https://pmc.ncbi.nlm.nih.gov/articles/PMC4267409/