There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the Research
Treatment Overview
The treatment for thyroid storm typically involves a multifaceted approach, including:
- Antithyroid medications, such as thionamides, to prevent further thyroid hormone synthesis 1, 2, 3
- Iodine solution to inhibit the release of thyroid hormone 1, 2
- Corticosteroids to reduce the risk of adrenal crisis and to inhibit the peripheral conversion of T4 to T3 1, 2
- Beta-blockers to control adrenergic symptoms, such as tachycardia and tremors, although they should be used with caution in patients with severe heart failure 1, 4, 2
- Cholestyramine to bind thyroid hormone in the gut and prevent its absorption 2
Alternative Treatment Options
In cases where standard treatment fails or is not tolerated, alternative options may be considered, including:
- Plasmapheresis to remove excess thyroid hormone from the blood 5, 2, 3
- Thyroidectomy as a definitive treatment option 5, 3
- Rectal administration of thionamides, such as propylthiouracil, in cases where oral access is not possible 3
Important Considerations
It is essential to note that thyroid storm is a clinical diagnosis, and laboratory tests alone may not be sufficient to establish a diagnosis 2. The Burch-Wartofsky point scale and Japan Thyroid Association diagnostic criteria can be used to support the diagnosis 2. Additionally, the use of iodinated contrast should be avoided until a thionamide has been administered, and the selection of a beta-blocker should be done with caution, taking into account the patient's individual circumstances 4.