Skip to main content

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