How is thyroid storm treated?

Patients who present with findings concerning for possible thyroid storm usually require careful monitoring of vital signs. In most cases this requires hospitalization in an intensive care unit set up to provide continuous measurement of a patient’s temperature, pulse, blood pressure, heart rhythm, and oxygenation. Patients who are delirious or agitated may need to be physically restrained to avoid injuring themselves. Patients who lapse into comas may need to have their breathing supported with a mechanical ventilator.

Specific treatment of thyroid storm usually involves the use of different types of medications that act in combination to block the production, secretion, and activity of thyroid hormone. Most patients with thyroid storm are treated with high doses of antithyroid drugs. These medications block the production of thyroid hormone in the thyroid gland. Propylthiouracil is usually the antithyroid drug of choice in this situation, as it may also work to block the conversion of T4 to T3. This may help to decrease the amount of active thyroid hormone present in the body. Propylthiouracil is usually administered orally, or through a tube passed through the nose into the stomach. Patients with thyroid storm may also be treated with iodine, a medication that blocks the secretion of thyroid hormone from the thyroid gland. Iodine may be administered in the form of a saturated solution of potassium iodide. It may also be administered in the form of an iodinated contrast agent called iopanoate. In particularly severe cases of prolonged thyroid storm, patients may be treated with lithium carbonate, a medication that blocks the secretion of thyroid hormone from the thyroid gland. Most patients with thyroid storm are treated with high doses of beta blockers. These medications may act to relieve some of the stimulation caused by exposure to excess amounts of thyroid hormone. They may be especially effective in slowing accelerated heart rates and suppressing abnormal heart rhythms. Propranolol is usually the beta blocker of choice in this situation, as it may also work to block the conversion of T4 to T3.

Supportive care may focus on controlling high fevers with high doses of acetaminophen and external cooling blankets, correcting dehydration with intravenous fluids, and providing adequate nutrition to support reserves that may have been depleted due to prolonged thyrotoxicosis.