Related Self Assessment Question A 58-year-old man presents with tachycardia, fever, confusion, and vomi-ting. Work-up reveals markedly elevated (triiodothyronine) T3 and (thyroxine) T4 levels. He is diagnosed as having a thyroid storm. Which of the following is the most appropriate next step in the management of this patient? A. Emergent subtotal thyroidectomy B. Emergent total thyroidectomy C. Emergent hemodialysis D. Administration of fluid, antithyroid drugs, β-blockers, iodine solution, and steroids E. Emergent radiation therapy to the neck EXPLANATION: Thyroid storm can be associated with high mortality rates if it is not appropriately managed in an intensive care unit setting. Treatment includes rapid fluid replacement, antithyroid medication such as propylthiouracil (PTU), β-blockers, iodine solutions, and steroids. β-Blockers are given to reduce peripheral conversion of T4 to T3 and decrease the hyperthyroid symptoms. Lugol iodine helps to decrease iodine uptake and thyroid hormone secretion. PTU therapy blocks formation of new thyroid hormone and reduces peripheral conversion of T4 to T3. Corticosteroids block hepatic thyroid hormone conversion. The thyroid storm needs to be treated before undergoing any surgery. Radiation therapy and hemodialysis have no role in the treatment of thyroid storm. The answer is D.
