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Thyroid storm — SCE Acute Medicine MCQ

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HardDiabetes and endocrine medicineThyroid stormSCE Acute Medicine

A patient with untreated Graves disease has fever 39.6°C, delirium, atrial fibrillation at 170/min, diarrhoea and pulmonary oedema. What treatment bundle is required?

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Correct answer: A — Give beta-blockade, thionamide, iodine and corticosteroid

The best answer is “Give beta-blockade, thionamide, iodine and corticosteroid”. This is correct because thyroid storm needs simultaneous control of adrenergic effects, new hormone synthesis, hormone release and peripheral conversion. Iodine must follow blockade of synthesis to avoid providing substrate. Single-agent treatment, acute radioiodine and thyroid-hormone replacement do not address this endocrine emergency.

Reference: Society for Endocrinology emergency guidance: acute hyperthyroidism: https://pmc.ncbi.nlm.nih.gov/articles/PMC5657262/