From the Guidelines
Thyroid storm treatment requires immediate, aggressive management with a multi-faceted approach, prioritizing propylthiouracil or methimazole, saturated solution of potassium iodide or sodium iodide, and dexamethasone as the cornerstone of therapy. The treatment should not be delayed for test results, and a standard series of drugs should be used to manage this extreme hypermetabolic state 1.
Key Components of Treatment
- Propylthiouracil or methimazole to block new thyroid hormone synthesis
- Saturated solution of potassium iodide or sodium iodide to prevent iodine utilization for new hormone synthesis
- Dexamethasone to reduce T4 to T3 conversion and treat potential adrenal insufficiency
- General supportive measures, such as oxygen, antipyretics, and appropriate monitoring, are also crucial 1
Additional Considerations
- The perceived underlying cause of thyroid storm should be treated
- Fetal status should be evaluated with ultrasound examination, nonstress testing, or a biophysical profile, depending on gestational age 1
- Delivery during thyroid storm should be avoided unless deemed necessary
- Phenobarbital may be used as an adjunctive treatment to control seizures or agitation 1
From the FDA Drug Label
Propylthiouracil inhibits the conversion of thyroxine to triiodothyronine in peripheral tissues and may therefore be an effective treatment for thyroid storm.
- Treatment for thyroid storm: Propylthiouracil may be an effective treatment for thyroid storm due to its ability to inhibit the conversion of thyroxine to triiodothyronine in peripheral tissues 2.
- Alternative treatment: Propranolol may mask certain clinical signs of hyperthyroidism, and abrupt withdrawal may be followed by an exacerbation of symptoms of hyperthyroidism, including thyroid storm 3.
From the Research
Treatment Options for Thyroid Storm
- The treatment regimen for thyroid storm incorporates several medications, including:
- Propranolol to inhibit the catecholamine-mediated peripheral effects of the circulating thyronines 4
- Propylthiouracil to inhibit thyroid hormone synthesis and to inhibit peripheral conversion of thyroxine to triiodothyronine (T3) 4, 5
- Iodine to block the glandular release of thyroid hormones 4, 6
- Dexamethasone along with general supportive therapy 4
- Methimazole is also used in the treatment of thyroid storm, with some studies showing no significant difference in outcomes compared to propylthiouracil 5, 6
- Corticosteroids may be used in the treatment of thyroid storm, particularly in patients with severe disease severity 6
- Beta-adrenergic antagonists, such as propranolol, may be used to control the symptoms of thyroid storm, with selective beta1-adrenergic antagonists potentially being preferable in severe cases 6
Comparison of Treatment Outcomes
- A comparative effectiveness study found no significant difference in mortality or adverse events between patients treated with propylthiouracil and those treated with methimazole for thyroid storm 5
- A retrospective analysis of nationwide surveys in Japan found no significant difference in mortality or disease severity between patients treated with methimazole and those treated with propylthiouracil 6
- The use of inorganic iodide, corticosteroids, and beta-adrenergic antagonists may be associated with higher disease severity, but their impact on mortality is unclear 6