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Thyroid storm — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardAcute Renal and Metabolic EmergenciesThyroid stormSCE Acute Medicine

A woman with untreated Graves disease has delirium, temperature 40.1°C, atrial fibrillation at 170/min, vomiting and heart failure. After resuscitation, a thionamide, glucocorticoid and cautious beta blockade are planned. Which sequencing detail is essential when adding iodide?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Give iodide at least 1 hour after the first thionamide dose

Explanation lettering: C = shown as A · A = shown as B · E = shown as C · B = shown as E

C is correct. In thyroid storm, the thionamide first blocks new hormone synthesis; iodide is then given at least one hour later to inhibit release. Iodide before or simultaneous with an unestablished synthesis block can provide substrate for hormone production. Waiting for biochemical euthyroidism forfeits the acute release-blocking effect, whereas radioiodine has no role as immediate storm therapy and may worsen an uncontrolled iodine-loaded state.

Reference: Endocrine and metabolic emergencies: thyroid storm: https://pmc.ncbi.nlm.nih.gov/articles/PMC3475282/