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Thyroid storm with atrial fibrillation — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesThyroid storm with atrial fibrillationSCE Acute Medicine

A 32-year-old woman presents two weeks after delivery with agitation, fever 39.2 C, HR 162 in atrial fibrillation and diarrhoea. She has a fine tremor, goitre and lid lag. TSH is suppressed and free T4 is markedly elevated. What is the most appropriate next step in management?

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Correct answer: B — Treat as thyroid storm with beta-blockade, antithyroid drug, iodine after thionamide and corticosteroid

Fever, severe thyrotoxicosis, gastrointestinal symptoms and AF indicate thyroid storm, requiring urgent multimodal treatment. Levothyroxine would worsen thyrotoxicosis. Radioiodine uptake testing is not appropriate in the emergency setting and is affected by iodine treatment. Beta-blockade alone is insufficient because hormone synthesis, release and peripheral conversion also need addressing.

Reference: Society for Endocrinology endocrine emergency guidance, BNF