Apathetic Thyroid Storm with Cardiorespiratory Failure, Pulmonary Embolism, and Coagulopathy in a Young Male with Graves’ Disease and Myopathy

Table 3

Drugs used in the management of thyroid storm [3, 6, 39].

Drug name	Treatment dose	Mechanism of action and comments
Propylthiouracil	500–1000 mg stat, then 200–250 mg every 4 hours	Blocks thyroid hormone synthesis; Blocks T4 ⟶ T3 conversion (>400 mg/day)
Carbimazole	25–30 mg every 4 hours	Blocks thyroid hormone synthesis
Methimazole	15–20 mg every 4 hours	Blocks thyroid hormone synthesis
Propranolol	60–80 mg every 4 hours	Ameliorates the β-adrenergic symptoms
Bisoprolol	2.5–5 mg/day	Blocks T4 ⟶ T3 conversion (at high doses: propranolol >160 mg/day); Aims heart rate (HR) <130/minute; Needs invasive monitoring in HF patients; Asthma: use diltiazem/verapamil
Esmolol	1 mg/kg IV over 30 seconds, 150 μg/kg/minute infusion
Landiolol	1 μg/kg/min as IV infusion; Dose range 1–10 μg/kg/min
Digoxin	0.125–0.25 mg intravenous	Use only with normal renal function
Lugol’s solution	5 drops or 0.25 mL or 250 mg every 6 hours	Blocks thyroid hormone synthesis and release. Administer 1 hour after ATD use
Lithium carbonate	300 mg every 8 hours	Blocks iodination and release
Cholestyramine	4 gm 3-4 times daily	Binds iodothyronines and removes them from the enterohepatic circulation
Hydrocortisone	300 mg IV stat, then; 100 mg every 8 hours	Inhibits release and T4 ⟶ T3 conversion; Prevents relative adrenal insufficiency; Promotes vascular stability
Dexamethasone	2 mg IV every 6 hours