Case Reports in Endocrinology / 2020 / Article / Tab 3

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 nameTreatment doseMechanism of action and comments

Propylthiouracil500–1000 mg stat, then 200–250 mg every 4 hoursBlocks thyroid hormone synthesis
Blocks T4 ⟶ T3 conversion (>400 mg/day)

Carbimazole25–30 mg every 4 hoursBlocks thyroid hormone synthesis

Methimazole15–20 mg every 4 hoursBlocks thyroid hormone synthesis

Propranolol60–80 mg every 4 hoursAmeliorates the β-adrenergic symptoms

Bisoprolol2.5–5 mg/dayBlocks 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
Esmolol1 mg/kg IV over 30 seconds, 150 μg/kg/minute infusion
Landiolol1 μg/kg/min as IV infusion
Dose range 1–10 μg/kg/min

Digoxin0.125–0.25 mg intravenousUse only with normal renal function

Lugol’s solution5 drops or 0.25 mL or 250 mg every 6 hoursBlocks thyroid hormone synthesis and release. Administer 1 hour after ATD use

Lithium carbonate300 mg every 8 hoursBlocks iodination and release

Cholestyramine4 gm 3-4 times dailyBinds iodothyronines and removes them from the enterohepatic circulation

Hydrocortisone300 mg IV stat, then
100 mg every 8 hours
Inhibits release and T4 ⟶ T3 conversion
Prevents relative adrenal insufficiency
Promotes vascular stability
Dexamethasone2 mg IV every 6 hours

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