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Thyroid storm in the postpartum period — SCE Acute Medicine MCQ

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HardDiabetes and endocrine medicineThyroid storm in the postpartum periodSCE Acute Medicine

Three months postpartum, a patient has palpitations, tremor, suppressed TSH and raised free T4 but no goitre, bruit or eye signs. TSH-receptor antibodies are negative. What is the best next step?

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Correct answer: D — Give oral antibiotics and arrange urgent drainage

The best answer is “Give oral antibiotics and arrange urgent drainage”. This is correct because destructive postpartum thyroiditis releases stored hormone and does not respond to antithyroid synthesis inhibitors. Symptoms may be managed with a compatible beta-blocker, followed by monitoring for a hypothyroid phase. Antibody testing, Doppler flow or uptake where appropriate helps distinguish Graves disease.

Reference: NICE NG145 thyroid-disease recommendations: https://www.nice.org.uk/guidance/ng145/chapter/Recommendations