From the Guidelines
Thyroid storm treatment should prioritize a multi-faceted approach, including beta-blockers, antithyroid medications, iodine solutions, and corticosteroids, to reduce morbidity and mortality. The treatment of thyroid storm involves several key components, including:
- Beta-blockers like propranolol (60-80 mg orally every 4-6 hours) to control heart rate and adrenergic symptoms, as supported by the 2022 study on individualized beta-blocker treatment 1
- Antithyroid medications such as methimazole (20-25 mg orally every 6 hours) or propylthiouracil (PTU, 200-400 mg orally every 4-6 hours) to block new thyroid hormone production, as recommended in the 2002 study on thyroid disease in pregnancy 1
- Iodine solutions like Lugol's solution (10 drops orally every 8 hours) or potassium iodide, added one hour after starting antithyroid drugs, to inhibit thyroid hormone release
- Corticosteroids, typically hydrocortisone (100 mg intravenously every 8 hours), to reduce T4 to T3 conversion and treat potential adrenal insufficiency
- Supportive care, including fever management with acetaminophen, cooling blankets, and treating the underlying trigger (infection, trauma, etc.), as well as intravenous fluids to address dehydration. The most recent and highest quality study, from 2022, highlights the importance of beta-blockers in treating thyrotoxicosis, including thyroid storm 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 (PO), as it inhibits the synthesis of thyroid hormones and the conversion of thyroxine to triiodothyronine in peripheral tissues 2.
- Key points:
- Propylthiouracil is effective in the treatment of hyperthyroidism.
- It may be an effective treatment for thyroid storm.
- The drug does not inactivate existing thyroxine and triodothyronine.
From the Research
Treatment for Thyroid Storm
The treatment for thyroid storm typically involves a combination of medications and supportive care. The primary goals of treatment are to:
- Decrease new hormone synthesis
- Inhibit the release of thyroid hormone
- Block the peripheral effects of thyroid hormone
Medications Used
Some of the medications used to treat thyroid storm include:
- Thionamides (such as methimazole or propylthiouracil) to prevent further thyroid hormone synthesis 3, 4, 5
- Iodine solution to inhibit the release of thyroid hormone 3, 5
- Beta-blockers (such as propranolol or esmolol) to block the peripheral effects of thyroid hormone 6, 5
- Corticosteroids to treat systemic complications 3, 5
Alternative Routes of Administration
In some cases, patients with thyroid storm may not be able to tolerate oral medications. Alternative routes of administration include:
- Intravenous methimazole (available in Europe and Japan) 3
- Rectal administration of thionamides (such as propylthiouracil) 3
- Suppository preparations of propylthiouracil and methimazole 3
Other Treatment Options
In extreme circumstances, other treatment options may be considered, such as: