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Table 3 Management of Thyroid Storm [34, 63]

From: Graves’ hyperthyroidism in pregnancy: a clinical review

ATD management (decreases the synthesis and release of T4 and T3) • PTU 100-150 mg PO every 8 h (PO, NGT) or
• MMI 20 mg PO every 12 h (PO, NGT) or
• MMI 40 mg in 200 cm3 water (Per rectum)
Non-selective beta blockade (symptomatic relief) to target:
B1 – Heart rate
B2 – Vasodilation
B3 – Basal metabolic rate and heat production
• Propranolol 1 mg IV bolus followed by 1 mg/h (target heart rate of 90–100 bpm if adequately hydrated)
T4 and T3 release • SSKI (potassium iodide) 5 drops or Lugol’s solution 10 drops every 8 h, 1 h after MMI (PO, NGT)
Generation of T3 • Decadron 4 mg IVPB every 6 h
• PTU at above doses decreases peripheral conversion of T4 to T3
Incorporation of T4 and T3 into the nucleus • L-carnitine 1-2 g twice a day [85]a
Fever • Aspirin may increase thyroid hormones and acetaminophen can interfere with steroids.
• Should improve with other treatment modalities.
Supportive care • Antibiotics as infection common precipitating event
• IVF –TS patients are at a fluid deficit. Fluid balance should be net positive.
• Recommend against active cooling as can lead to peripheral vasoconstriction and hinder release of heat
• Avoid aggressive use of diuretics. Intravascular depletion can lead to cardiovascular collapse
• Low threshold to intubate
  1. PO per oral, NGT nasogastric tube, PR per rectum, IVF intravenous fluids
  2. aNo studies in pregnant patients