Thyroid Disease in the Intensive Care Unit

Chapter 53 Thyroid Disease in the Intensive Care Unit







3 How do you treat thyroid storm?


Use common sense. First, support the patient as you would any critically ill patient and be sure to initiate cardiac monitoring. Next, reduce thyroid hormone production with thioureas. Finally, stop release of preformed hormone by adding iodide. Simultaneously with these measures give β-blockade to slow heart rate and reduce conversion of T4 to T3 (see Table 53-1).


Table 53-1 Supportive Care and Specific Medications for Thyroid Storm















































































Intervention and mechanism of action Dose Route
Supportive care
Isotonic fluids Patient specific IV
Oxygen Patient specific Nasal cannula if stable enough
Cooling blanket   Topical
Acetaminophen or other antipyretics Adult dosing Oral, rectal, or NG
Thioureas: reduce thyroid hormone production
Propylthiouracil 150 mg every 6 hr Oral, rectal, or NG
Methimazole (Tapazole) 20 mg every 8 hr Oral, rectal, or NG
Iodide: reduce hormone production and T4 to T3 conversion 2-4 hr after starting thioamide (above)
Saturated solution of potassium iodide 5 drops (250 mg) twice daily Oral
Iopanoic acid 0.5 g twice daily Oral or IV
Iohexol 0.6 g (2 mL of Omnipaque 300) twice daily IV
β-Blockade: reduce heart rate and reduce conversion of T4 to T3
Propranolol 40-80 mg every 6 hr Oral
Propranolol 0.5-1.0 mg over 10 min every 3 hr IV
Esmolol (especially if patient has asthma and needs β1-selective agent) 0.25-0.5 mg/kg bolus followed by 0.05-0.1 mg/kg/min infusion IV
Glucocorticoids: support circulation, supplement glucocorticoid reserve because of increased metabolism and reduced half-life with thyrotoxicosis, and reduce T4 to T3 conversion
Dexamethasone 2 mg every 6 hr × 48 hr, then taper dose rapidly Oral or IV
Hydrocortisone 100 mg every 8 hr × 48 hr, then taper dose rapidly IV
Resin binders: remove T4 in the gut to reduce enterohepatic circulation of free T4
Cholestyramine or colestipol 20-30 g daily Oral or NG

IV, Intravenous; NG, nasogastric.

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Jul 6, 2016 | Posted by in CRITICAL CARE | Comments Off on Thyroid Disease in the Intensive Care Unit

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