Table 3 Management of Thyroid Storm [34, 63]
From: Graves’ hyperthyroidism in pregnancy: a clinical review
| ATD management (decreases the synthesis and release of T4 and T3) |
• PTU 100-150 mg PO every 8 h (PO, NGT) or • MMI 20 mg PO every 12 h (PO, NGT) or • MMI 40 mg in 200 cm3 water (Per rectum) |
|
Non-selective beta blockade (symptomatic relief) to target: B1 – Heart rate B2 – Vasodilation B3 – Basal metabolic rate and heat production | • Propranolol 1 mg IV bolus followed by 1 mg/h (target heart rate of 90–100 bpm if adequately hydrated) |
| T4 and T3 release | • SSKI (potassium iodide) 5 drops or Lugol’s solution 10 drops every 8 h, 1 h after MMI (PO, NGT) |
| Generation of T3 |
• Decadron 4 mg IVPB every 6 h • PTU at above doses decreases peripheral conversion of T4 to T3 |
| Incorporation of T4 and T3 into the nucleus | • L-carnitine 1-2 g twice a day [85]a |
| Fever |
• Aspirin may increase thyroid hormones and acetaminophen can interfere with steroids. • Should improve with other treatment modalities. |
| Supportive care |
• Antibiotics as infection common precipitating event • IVF –TS patients are at a fluid deficit. Fluid balance should be net positive. • Recommend against active cooling as can lead to peripheral vasoconstriction and hinder release of heat • Avoid aggressive use of diuretics. Intravascular depletion can lead to cardiovascular collapse • Low threshold to intubate |