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Thyroid storm — SCE Endocrinology MCQ

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HardThyroidThyroid stormSCE Endocrinology

A 46-year-old woman has severe thyrotoxicosis, fever, agitation and atrial fibrillation after iodinated contrast for CT. TSH is suppressed, free T4 is 68 pmol/L and she has a multinodular goitre. She is vomiting and hypotensive. What is the most appropriate management?

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Correct answer: E — Treat thyroid storm with beta-blockade, thionamide, iodine after thionamide, glucocorticoid and supportive care

Treat thyroid storm with beta-blockade, thionamide, iodine after thionamide, glucocorticoid and supportive care is best because thyroid storm requires immediate multimodal therapy that blocks adrenergic effects, hormone synthesis, hormone release and peripheral conversion. The alternatives are less appropriate because iodine before thionamide may provide substrate; levothyroxine is harmful; outpatient radioiodine is too slow; fluids alone are inadequate. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/diabetes-and-other-endocrinal-nutritional-and-metabolic-conditions