Table 2.

Medical management of thyroid storm.

Medication	Dose	Notes
Inhibition of hormone synthesis
Propylthiouracil (PTU)	600 mg loading dose, followed by 200–250 mg PO q4–6h	Additional inhibition of peripheral deiodination However, recent warning from FDA regarding severe liver toxicity with PTU makes either carbimazole or methimazole first-choice thionamide
Carbimazole (or methimazole)	20–30 mg PO q4–6h
Inhibition of hormone release
SSKI (Potassium Iodide)	5 drops PO q6–8h	Administer at least 1 hour after thionamide
Lugol's Solution	5–10 drops PO q6–8h In UK, 1 ml PO q6h	Administer at least 1 hour after thionamide
Iapanoic Acid	1000 mg IV q8h for 24 h, followed by 500 mg bd	Administer at least 1 hour after thionamide, infrequently available
Inhibition of peripheral effects of excess thyroid hormone
Propranolol	1–2 mg/min IV q15min up to max 10 mg 40–80 mg PO q4–6h	IV dose initially if haemodynamically unstable
Esmolol	50 μg/kg/min IV—may increase by 50 μg/kg/min q4min as required to a max of 300 μg/kg/min.	Short acting
Metoprolol	100 mg PO q6h	Cardioselective; use if known airways disease
Diltiazem	60–90 mg PO q6–8h	Use if beta-blockers contraindicated IV formulation available
Supplementary management
Hydrocortisone	100 mg IV q6h
Dexamethasone	2 mg IV q6h
Acetaminophen (commonly known as paracetamol or Tylenol)	1 g PO q6h	Care if significant hepatic dysfunction
Additional therapies
Lithium Carbonate	300 mg PO q8h	Monitor for toxicity
Potassium perchlorate	1 g PO od	Associated with aplastic anaemia and nephritic syndrome
Cholestyramine	4g PO q6–12h

PO, oral; IV, intravenous; q4–6h, every 4–6 hours; q6h, every 6 hours; q8h, every 8 hours; q4min, every 4 minutes; q15min, every 15 minutes; od, once daily; bd, twice daily.