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Thyroid storm — ABIM Board MCQ

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HardEndocrinology/MetabolismThyroid stormABIM Board

A 36-year-old woman with Graves disease stopped methimazole. She presents with fever, agitation, diarrhea, and atrial fibrillation with rapid ventricular response. Temperature is 40.1 C, blood pressure is 154/66 mm Hg, and pulse is 154/min. Free T4 is markedly elevated and TSH is undetectable. Which of the following is the most appropriate management?

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Correct answer: C — Propranolol, propylthiouracil, iodine after thionamide, glucocorticoids, and supportive care

Thyroid storm requires immediate supportive care, beta-blockade, thionamide therapy, iodine after thionamide to block hormone release, and glucocorticoids. Radioactive iodine has no role in acute stabilization.

Reference: American Thyroid Association Hyperthyroidism Guideline