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Thyroid storm — RCPSC IM MCQ

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HardEndocrinologyThyroid stormRCPSC IM

A 45-year-old with untreated Graves disease has fever, delirium, atrial fibrillation and heart failure. What treatment sequence is appropriate?

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Correct answer: DGive a thionamide, then iodine, plus beta blockade as tolerated and glucocorticoid

The best answer is “Give a thionamide, then iodine, plus beta blockade as tolerated and glucocorticoid”. Thyroid storm requires simultaneous supportive care, adrenergic control, thionamide therapy, iodine after thionamide and glucocorticoid. Giving iodine first can supply substrate for new hormone synthesis; radioiodine acts too slowly and surgery generally follows stabilization.

Reference: Ontario Poison Centre, clinical resources and protocols: https://www.ontariopoisoncentre.ca/health-care-professionals/clinical-resources-and-protocols/