From the Guidelines
Thyroid storm treatment requires immediate medical intervention with a multi-faceted approach, prioritizing beta-blockers, antithyroid medications, iodine solutions, and corticosteroids to control symptoms and prevent morbidity and mortality. The treatment of thyroid storm involves a combination of medications to reduce thyroid hormone production and release, as well as supportive care to manage systemic symptoms.
Key Components of Treatment
- Beta-blockers like propranolol (60-80 mg orally every 4-6 hours) are given to control cardiovascular symptoms, as recommended by the American Association of Clinical Endocrinologists Medical Guidelines for the Evaluation and Treatment of Hyperthyroidism and Hypothyroidism 1.
- Antithyroid medications such as methimazole (20-25 mg orally every 6 hours) or propylthiouracil (PTU, 200-400 mg orally every 4-6 hours) are administered to block new thyroid hormone production, as suggested by the study on thyroid disease in pregnancy 1.
- One hour after starting antithyroid drugs, iodine solutions like Lugol's solution (10 drops orally every 8 hours) or potassium iodide are added to inhibit thyroid hormone release.
- Corticosteroids such as hydrocortisone (100 mg intravenously every 8 hours) help reduce T4 to T3 conversion and treat potential adrenal insufficiency.
Supportive Care
- Supportive care includes intravenous fluids, cooling measures for hyperthermia, glucose supplementation, and treating the underlying trigger.
- Patients require ICU monitoring with frequent vital sign checks and thyroid function tests. This comprehensive approach targets the excessive thyroid hormone production and systemic effects while addressing the precipitating cause of the thyroid storm, ultimately reducing morbidity, mortality, and improving quality of life 1.
From the FDA Drug Label
Propylthiouracil inhibits the conversation of thyroxine to triiodothyronine to peripheral tissues and may therefore be an effective treatment for thyroid storm. The treatment for a thyroid storm may include propylthiouracil as it inhibits the conversion of thyroxine to triiodothyronine, which can help in managing the condition 2.
- Key points:
- Propylthiouracil is used to treat hyperthyroidism.
- It may be effective in treating thyroid storm by inhibiting the conversion of thyroxine to triiodothyronine.
From the Research
Treatment for Thyroid Storm
The treatment for thyroid storm is a multidrug, therapeutic approach that aims to decrease new hormone synthesis, inhibit the release of thyroid hormone, and block the peripheral effects of thyroid hormone 3. The following are some of the key components of treatment:
- Decreasing new hormone synthesis using thionamides such as methimazole (MMI) or propylthiouracil (PTU) 4, 3
- Inhibiting the release of thyroid hormone using iodine 3
- Blocking the peripheral effects of thyroid hormone using beta-adrenergic receptor antagonists 3, 5
- Using corticosteroids in certain circumstances 3, 5
- Supportive therapy to manage systemic complications 3, 6
- Alternative therapy with cholestyramine, lithium carbonate, or potassium perchlorate may be considered in certain cases 3
Role of Therapeutic Plasma Exchange
Therapeutic plasma exchange (TPE) is an ASFA category III indication for thyroid storm, meaning the optimum role of this therapy is not established, and there are a limited number of cases in the literature 4. However, TPE can remove T3 and T4 bound to albumin, autoantibodies, catecholamines, and cytokines, and is likely beneficial for patients who cannot tolerate or fail pharmacotherapy, especially if they cannot undergo thyroidectomy 4.
Importance of Early Recognition and Treatment
Early recognition and treatment of thyroid storm are critical to preventing mortality, which can range from 10-50% if left untreated or inadequately treated 6, 7. Any delay in therapy can lead to a significant increase in mortality rate, and medical treatment should be based on three principles: counteracting the peripheral effects of thyroid hormones, inhibition of thyroid hormone synthesis, and treatment of systemic complications 6.