Case Report
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 |
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