{
  "schemaVersion": 2,
  "eyebrow": "Endocrine emergency",
  "title": "Thyroid Storm Treatment Sequence",
  "summary": "Treat suspected thyroid storm as an ICU emergency: resuscitate and treat the trigger while rapidly blocking adrenergic effects, hormone synthesis, hormone release, peripheral conversion, and enterohepatic recirculation in a timed sequence.",
  "seoDescription": "ICU sequence for thyroid storm: stabilization, beta-blockade, thionamides, timed iodine, glucocorticoids, cholestyramine, and rescue escalation.",
  "clinicalQuestion": "What is the optimal ICU treatment sequence for suspected thyroid storm?",
  "specialty": "Endocrinology and Critical Care Medicine",
  "audience": "U.S. physicians and medical trainees",
  "tags": [
    "thyroid storm treatment sequence",
    "thyrotoxic crisis",
    "PTU dosing",
    "methimazole dosing",
    "iodine after thionamide",
    "esmolol thyroid storm",
    "plasmapheresis thyroid storm"
  ],
  "keyTakeaways": [
    "Do not wait for thyroid testing to begin ICU-level multimodal treatment when clinical features suggest thyroid storm; use Burch-Wartofsky or Japanese Thyroid Association criteria to support, not delay, the diagnosis.[1][2][17]",
    "Give a thionamide before iodine; ATA-oriented guidance delays iodine for about 1 hour, whereas Japanese guidance permits concurrent potassium iodide and antithyroid-drug administration.[3][4][16]",
    "Use beta-blockade only after assessing for decompensated heart failure, hypotension, and shock; esmolol is useful when rapidly titratable ICU control is needed.[2][15][18]",
    "Add glucocorticoid and consider cholestyramine early in severe disease; reserve therapeutic plasma exchange for medically refractory cases or when standard therapy cannot be used.[15][18][19]"
  ],
  "sections": [
    {
      "id": "activate-icu-and-treat-in-parallel",
      "eyebrow": "First minutes",
      "heading": "Initiate ICU treatment on clinical suspicion",
      "intro": "Treat the syndrome and its precipitant simultaneously rather than waiting for biochemical confirmation.",
      "paragraphs": [
        "Admit suspected thyroid storm to an ICU with continuous cardiac monitoring and ventilatory support when needed.[15][17] Diagnosis is clinical; no single thyroid hormone value establishes storm. Use the Burch-Wartofsky Point Scale or Japanese Thyroid Association criteria to structure assessment, while recognizing that both rely on systemic decompensation rather than a diagnostic free T4 or T3 cutoff.[1][2][4]",
        "Obtain thyroid tests and evaluate for the precipitant, but start therapy immediately when fever, marked tachycardia or atrial arrhythmia, central nervous system dysfunction, gastrointestinal/hepatic dysfunction, heart failure, hypotension, or shock accompany thyrotoxicosis.[2][17][24] Infection, acute myocardial infarction, stroke, heart failure, trauma, surgery, antithyroid-drug discontinuation, radioiodine, iodinated contrast, and pregnancy—especially labor and delivery—are recognized precipitants that require targeted treatment or avoidance of further exposure.[20]",
        "Resuscitate with intravenous fluids, oxygen, external cooling, and acetaminophen; use cooling blankets when needed.[15] Avoid aspirin because displacement of thyroid hormone from binding proteins can increase free hormone levels.[17] Treat agitation and hyperthermia in parallel, assess respiratory failure early, and direct hemodynamic support to the observed phenotype rather than assuming tachycardia is solely adrenergic.[17]"
      ],
      "bullets": [
        "Send TSH and free thyroid hormones, but do not use laboratory turnaround as a reason to defer treatment.[2][7]",
        "Screen immediately for infection and other acute triggers, then institute trigger-specific therapy concurrently with antithyroid treatment.[2][15][20]",
        "Assess for atrial fibrillation, pulmonary edema, cardiogenic shock, hepatic dysfunction, and altered consciousness because these complications determine beta-blocker safety and organ support needs.[17][24]"
      ],
      "subsections": [],
      "table": {
        "caption": "First-hour management priorities in suspected thyroid storm.[2][15][17][20]",
        "columns": [
          "Priority",
          "Action",
          "What changes next"
        ],
        "rows": [
          [
            "Level of care",
            "ICU admission with continuous cardiac monitoring; provide ventilatory support if required.[15][17]",
            "Permits titration of rate control and rapid response to heart failure, shock, or respiratory failure."
          ],
          [
            "Temperature and volume",
            "IV fluids, oxygen, cooling measures, and acetaminophen; avoid aspirin.[15][17]",
            "Corrects dehydration and hyperthermia while definitive therapy lowers hormone effect."
          ],
          [
            "Trigger",
            "Evaluate and treat infection, acute cardiovascular or neurologic illness, trauma, medication withdrawal, iodinated contrast exposure, surgery, or pregnancy-related stress.[20]",
            "Persistent deterioration should prompt reassessment for an untreated precipitant."
          ],
          [
            "Diagnostic support",
            "Apply Burch-Wartofsky or Japanese Thyroid Association criteria while obtaining thyroid tests.[1][2]",
            "A high clinical likelihood warrants full treatment without waiting for results."
          ]
        ]
      }
    },
    {
      "id": "block-adrenergic-effects-safely",
      "eyebrow": "Step 1",
      "heading": "Control adrenergic toxicity after hemodynamic assessment",
      "intro": "Rate control is urgent, but beta-blockade can be hazardous in low-output heart failure or shock.",
      "paragraphs": [
        "In patients without severe heart failure, initiate a beta-blocker promptly to control tachycardia and adrenergic manifestations.[2][16] Oral propranolol is commonly used at 10 to 40 mg three or four times daily; alternatives include metoprolol 25 to 50 mg two or three times daily or atenolol 25 to 100 mg once or twice daily.[18] Propranolol also reduces T4-to-T3 conversion, although beta-blockers’ principal acute benefit is control of beta-adrenergic tone.[7][16]",
        "For severe storm managed in the ICU, use titratable esmolol: a 250 to 500 mcg/kg loading dose followed by 50 to 100 mcg/kg/min is one described regimen; another review describes 50 to 100 mcg/kg/min for severe ICU-level illness.[15][18] Its short duration is advantageous when blood pressure, cardiac output, or pulmonary edema may deteriorate during rate control.",
        "Do not reflexively administer beta-blockade in severe heart failure, hypotension, or shock. The emergency-care literature specifically limits beta-blocker use to patients without severe heart failure.[2] If beta-blockers are contraindicated, diltiazem is an alternative; for reactive airway disease, atenolol or metoprolol are identified alternatives to nonselective beta-blockade.[15]"
      ],
      "bullets": [
        "Use propranolol when enteral administration is feasible and hemodynamics are stable: 10 to 40 mg orally three or four times daily.[18]",
        "Use esmolol in an ICU when a rapidly titratable agent is needed: 250 to 500 mcg/kg loading dose, then 50 to 100 mcg/kg/min.[15]",
        "Select metoprolol or atenolol rather than a nonselective agent in reactive airway disease; avoid atenolol in pregnancy according to the cited review.[15][18]"
      ],
      "subsections": [],
      "table": {
        "caption": "Beta-adrenergic treatment choices and limiting conditions.[2][15][18]",
        "columns": [
          "Clinical setting",
          "Agent and dose",
          "Key limitation"
        ],
        "rows": [
          [
            "Hemodynamically stable; enteral route available",
            "Propranolol 10-40 mg orally three or four times daily.[18]",
            "Avoid or withhold if severe heart failure develops.[2]"
          ],
          [
            "Need rapid ICU titration",
            "Esmolol 250-500 mcg/kg loading dose, then 50-100 mcg/kg/min.[15]",
            "Requires continuous monitoring; reassess immediately for hypotension or low-output physiology."
          ],
          [
            "Reactive airway disease",
            "Atenolol 25-100 mg once or twice daily or metoprolol 25-50 mg two or three times daily.[15][18]",
            "Atenolol is avoided in pregnancy.[18]"
          ],
          [
            "Beta-blocker contraindicated",
            "Diltiazem as an alternative.[15]",
            "Does not replace antithyroid, iodine, glucocorticoid, or trigger-directed therapy."
          ]
        ]
      }
    },
    {
      "id": "block-synthesis-before-iodine",
      "eyebrow": "Steps 2 and 3",
      "heading": "Administer thionamide, then timed inorganic iodine",
      "intro": "The order prevents administered iodine from serving as substrate for new hormone synthesis.",
      "paragraphs": [
        "Give a thionamide to inhibit new thyroid hormone synthesis. One high-dose regimen is propylthiouracil (PTU) 500 to 1,000 mg loading dose, then 250 mg every 4 hours orally or intravenously, with a reported maximum of 1,600 mg/day.[18] Methimazole (MMI) is an alternative at 60 to 80 mg/day, with a reported maximum of 100 mg/day; intravenous MMI is not available in the United States.[18]",
        "After the thionamide, administer nonradioactive iodine to rapidly inhibit hormone synthesis and release through the acute Wolff-Chaikoff effect.[3][4] ATA-oriented guidance recommends waiting about 1 hour after thionamide administration; another review specifies at least 30 minutes. The Japanese approach differs by allowing potassium iodide and antithyroid drug to begin concurrently.[3][4][16] In U.S. practice, preserve the thionamide-first sequence unless a protocol explicitly follows the concurrent Japanese strategy.",
        "Use PTU or MMI with awareness of serious toxicities: agranulocytosis, hepatotoxicity, and ANCA-positive vasculitis are major adverse effects reported for both drugs.[18] If thionamides are contraindicated because of allergy, stabilize with beta-blockade when tolerated, hydrocortisone, cholestyramine, and iodine, then pursue thyroidectomy; therapeutic plasma exchange is a last-resort bridge when other measures fail.[15]",
        "Stop iodine once clinical and thyroid-function improvement occurs; one review notes improvement generally within 24 hours after initial storm presentation.[4] Continue antithyroid therapy until euthyroidism, then select definitive therapy—radioiodine or thyroidectomy—according to the underlying hyperthyroid disorder and patient circumstances.[15][20]"
      ],
      "bullets": [
        "PTU option: 500-1,000 mg loading dose, then 250 mg every 4 hours; maximum reported dose 1,600 mg/day.[18]",
        "MMI option: 60-80 mg/day; reported maximum 100 mg/day; no U.S. intravenous formulation.[18]",
        "Give iodine at least 30 minutes to 1 hour after the thionamide in ATA-oriented sequencing.[4][16]",
        "Do not continue iodine indefinitely; stop after improvement and transition to definitive planning once euthyroid.[4][20]"
      ],
      "subsections": [],
      "table": {
        "caption": "Hormone-directed sequence in thyroid storm.[3][4][15][16][18]",
        "columns": [
          "Order",
          "Intervention",
          "Dose or timing",
          "Clinical purpose"
        ],
        "rows": [
          [
            "2",
            "PTU",
            "500-1,000 mg loading dose, then 250 mg every 4 hours; maximum reported dose 1,600 mg/day.[18]",
            "Inhibits new hormone synthesis; also targets peripheral T4-to-T3 conversion.[6][18]"
          ],
          [
            "2",
            "MMI",
            "60-80 mg/day; reported maximum 100 mg/day.[18]",
            "Alternative thionamide for inhibition of hormone synthesis."
          ],
          [
            "3",
            "Inorganic iodine",
            "Give at least 30 minutes to approximately 1 hour after thionamide in ATA-oriented practice.[4][16]",
            "Rapidly blocks thyroid hormone synthesis and release through the acute Wolff-Chaikoff effect.[3][4]"
          ],
          [
            "Transition",
            "Discontinue iodine after improvement; continue antithyroid treatment until euthyroid.[4][20]",
            "Avoids prolonged iodine exposure while preparing definitive treatment."
          ]
        ]
      }
    },
    {
      "id": "reduce-conversion-and-clearance",
      "eyebrow": "Step 4",
      "heading": "Add glucocorticoid and cholestyramine early in severe storm",
      "intro": "These adjuncts target peripheral conversion, possible adrenal insufficiency, and enterohepatic hormone recirculation.",
      "paragraphs": [
        "Administer corticosteroids to reduce peripheral thyroid hormone conversion and address possible overt or partial adrenal insufficiency.[17] A reported ICU regimen is hydrocortisone 100 mg every 8 hours.[17] Taper and discontinue glucocorticoids after clinical improvement, while adjusting beta-blocker therapy and titrating the thionamide.[15]",
        "Add cholestyramine to interrupt enterohepatic recirculation and increase thyroid hormone excretion, particularly in severe or incompletely controlled storm.[17][19] A reported regimen is 1 to 4 g orally one to four times daily; administer it 1 hour before other medications because it can reduce their absorption.[18] Short courses of up to 4 weeks were reported as well tolerated, but bloating, constipation, and flatulence are expected adverse effects.[18]",
        "If PTU was selected during the acute phase, switch to methimazole after improvement according to the cited management review, then pursue radioiodine or thyroidectomy as definitive treatment when the patient is clinically stable.[15]"
      ],
      "bullets": [
        "Hydrocortisone: 100 mg every 8 hours is a reported ICU regimen.[17]",
        "Cholestyramine: 1-4 g orally one to four times daily; give 1 hour before other drugs to limit absorption interference.[18]",
        "After stabilization, taper glucocorticoid, adjust beta-blocker, and transition PTU to MMI when PTU was used initially.[15]"
      ],
      "subsections": [],
      "table": {
        "caption": "Adjunctive therapy after thionamide and timed iodine.[15][17][18][19]",
        "columns": [
          "Adjunct",
          "Regimen",
          "Role and monitoring implication"
        ],
        "rows": [
          [
            "Hydrocortisone",
            "100 mg every 8 hours in a reported ICU regimen.[17]",
            "Reduces peripheral conversion and covers possible adrenal insufficiency; taper after improvement.[15][17]"
          ],
          [
            "Cholestyramine",
            "1-4 g orally one to four times daily; administer 1 hour before other medications.[18]",
            "Interrupts enterohepatic circulation; monitor for bloating, constipation, and flatulence.[18]"
          ],
          [
            "Transition after improvement",
            "Taper glucocorticoid, adjust beta-blocker, and switch initial PTU to MMI.[15]",
            "Continue antithyroid treatment until euthyroidism and plan definitive therapy.[15][20]"
          ]
        ]
      }
    },
    {
      "id": "refractory-storm-and-definitive-control",
      "eyebrow": "Escalation",
      "heading": "Escalate refractory storm and prevent recurrence",
      "intro": "Failure to stabilize requires reassessment of both the precipitant and feasibility of hormone-directed therapies.",
      "paragraphs": [
        "For ongoing deterioration despite ICU support, beta-adrenergic control when tolerated, thionamide, timed iodine, glucocorticoid, cholestyramine, and treatment of the precipitant, reassess for uncontrolled infection, cardiovascular decompensation, continued iodine exposure, or inability to absorb enteral therapy.[2][16][17][20] Critically ill patients may require rectal formulations; intravenous MMI is described in some settings but is not available in the United States, and PTU is poorly soluble for intravenous use according to the amiodarone-focused review.[16][18]",
        "Consider therapeutic plasma exchange for medically refractory storm or when standard treatment is contraindicated or ineffective; it can rapidly lower circulating thyroid hormone, but available evidence frames it as rescue therapy rather than routine first-line management.[15][19][22] When thionamides cannot be used because of allergy, thyroidectomy after stabilization with beta-blockade when tolerated, hydrocortisone, cholestyramine, and iodine is an identified definitive pathway.[15]",
        "After recovery, continue antithyroid therapy until euthyroidism and establish definitive control with radioiodine or thyroidectomy when appropriate.[15][20] Prevention includes avoiding abrupt antithyroid-drug discontinuation and ensuring euthyroidism before elective surgery and labor or delivery.[20] Thyroid storm has reported mortality up to 22%, with other reports citing 10% to 30%, reinforcing the need for early ICU-level treatment and trigger control.[4][7][19]"
      ],
      "bullets": [
        "Use therapeutic plasma exchange as rescue therapy for drug-refractory disease or when conventional therapy is not feasible.[15][19][22]",
        "Consider thyroidectomy after stabilization when thionamides are contraindicated by allergy.[15]",
        "Before elective surgery or labor and delivery, achieve euthyroidism whenever possible; counsel patients not to stop antithyroid drugs abruptly.[20]"
      ],
      "subsections": [],
      "table": {
        "caption": "Rescue and post-stabilization decisions.[15][19][20][22]",
        "columns": [
          "Problem",
          "Next action",
          "Role in sequence"
        ],
        "rows": [
          [
            "Medical therapy ineffective or cannot be used",
            "Consider therapeutic plasma exchange.[15][19][22]",
            "Rescue bridge to biochemical and clinical control, not routine initial therapy."
          ],
          [
            "Thionamide allergy",
            "Stabilize with beta-blocker when tolerated, hydrocortisone, cholestyramine, and iodine; proceed to thyroidectomy.[15]",
            "Provides definitive control when thionamides are contraindicated."
          ],
          [
            "Recovered from storm",
            "Continue antithyroid treatment until euthyroid, then choose radioiodine or thyroidectomy as appropriate.[15][20]",
            "Reduces recurrence risk from persistent hyperthyroidism."
          ],
          [
            "Future stressor",
            "Avoid abrupt antithyroid-drug cessation; achieve euthyroidism before elective surgery and labor/delivery.[20]",
            "Prevents recurrent storm."
          ]
        ]
      }
    }
  ],
  "faq": [],
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      "title": "Thyroid Crisis - an overview",
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  ],
  "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.",
  "citations": [
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      "authors": "jitc.bmj.com",
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      "snippet": "likelihood of thyroid storm should be made using the. Burch- Wartofsky Point Scale or the Japanese Thyroid. Association Criteria.63 64 TSH receptor antibody",
      "score": 0.6002124
    },
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      "title": "High risk and low prevalence diseases: Thyroid storm",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S073567572300150X",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
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      "score": 0.74318707
    },
    {
      "number": 3,
      "title": "Review Article Iodine and Hyperthyroidism: A Double-Edged Sword",
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      "url": "https://www.sciencedirect.com/science/article/pii/S1530891X24008103",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Japanese guidelines for treatment of thyroid storm vary slightly from the American guidelines, in that they recommend starting KI and ATD concurrently.",
      "score": 0.6493346
    },
    {
      "number": 4,
      "title": "Iodine and Hyperthyroidism: A Double-Edged Sword",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S1530891X24008103",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "cause the acute Wolf–Chaikoff effect, rapidly blocking thyroid hormone synthesis), corticosteroid therapy, and monitoring in an intensive care unit.43 According to ATA recommendations, iodine administration should be delayed until an hour after administration of thionamide, to prevent iodine-induced",
      "score": 0.5999311
    },
    {
      "number": 5,
      "title": "Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S1530891X20404185",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "authors believe is current, rational, and optimal medi cal practice for the diagnosis and care of hypothyroidism. A serum thyrotropin is the single best screening test for primary thyroid dysfunction for the vast majority of outpa tient clinical situations. The standard treatment is replace ment wit",
      "score": 0.54187006
    },
    {
      "number": 6,
      "title": "Thyroid Storm with Multiorgan Failure Treated with Plasmapheresis",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/10.1155/2019/2475843",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "First line treatment of thyroid storm is directed towards decreasing thyroid hormone production and peripheral conversion of T4 to T3, and",
      "score": 0.31986502
    },
    {
      "number": 7,
      "title": "Thyroid Storm in Pregnancy : Bali Journal of Anesthesiology",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/bjoa/fulltext/2021/05020/thyroid_storm_in_pregnancy.14.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "The diagnosis of thyroid storm can be established based on the clinical condition of the patient. Laboratory evaluation takes a long time, so it is not practical for an emergency. One of the clinical criteria that can be used is Burch–Wartofsky Point Scale (BWPS). Based on the BWPS thyroid storm cri",
      "score": 0.50564
    },
    {
      "number": 8,
      "title": "New Guidelines for Diagnosis and Management of Hyperthyroid Disease Presented in Thyroid Journal | American Thyroid Association",
      "detail": "www.thyroid.org",
      "url": "https://www.thyroid.org/new-guidelines-for-diagnosis-and-management-of-hyperthyroid-disease-presented-in-thyroid-journal",
      "authors": "www.thyroid.org",
      "host": "www.thyroid.org",
      "snippet": "A task force representing the ATA and AACE reviewed the medical literature and current standards of care and developed new guidelines that include recommendations for the following: initial evaluation and management of thyrotoxicosis; treatment of GD using radioactive iodine, antithyroid drugs, or s",
      "score": 0.67347145
    },
    {
      "number": 9,
      "title": "New Guidelines for Anaplastic Thyroid Cancer |  American Thyroid Association",
      "detail": "www.thyroid.org",
      "url": "https://www.thyroid.org/guidelines",
      "authors": "www.thyroid.org",
      "host": "www.thyroid.org",
      "snippet": "American Thyroid Association\n\n# New Guidelines for Anaplastic Thyroid Cancer\n\nAmerican Thyroid Association\n\nNew Rochelle, NY, March 17, 2021—New guidelines for the diagnosis, evaluation, and treatment of anaplastic thyroid cancer (ATC) reflect the significant clinical and scientific advances that ha",
      "score": 0.64047897
    },
    {
      "number": 10,
      "title": "American Thyroid Association Guidelines for Diagnosis and ...",
      "detail": "www.thyroid.org",
      "url": "https://www.thyroid.org/association-guidelines-management",
      "authors": "www.thyroid.org",
      "host": "www.thyroid.org",
      "snippet": "New evidence-based recommendations from the American Thyroid Association (ATA) provide guidance to clinicians in diagnosing and managing thyroid disease during pregnancy and the postpartum period. Pregnancy has a profound effect on thyroid gland function, and thyroid disease is common in pregnancy. ",
      "score": 0.6353361
    },
    {
      "number": 11,
      "title": "ATA Guidelines & Statements |  American Thyroid Association",
      "detail": "www.thyroid.org",
      "url": "https://www.thyroid.org?p=16504",
      "authors": "www.thyroid.org",
      "host": "www.thyroid.org",
      "snippet": "Additional Resources\n\nthy.2023.33.issue-9  \nThyroid Stimulating Hormone and Thyroid Hormones (Triiodothyronine and Thyroxine): An American Thyroid Association-Commissioned Review of Current Clinical and Laboratory Status  \nKatleen Van Uytfanghe, et al., THYROID Volume 33, Number 9, 2023.Thyroid® 202",
      "score": 0.58948064
    },
    {
      "number": 12,
      "title": "[PDF] Thyroid Emergencies - CDC Stacks",
      "detail": "stacks.cdc.gov",
      "url": "https://stacks.cdc.gov/view/cdc/58372/cdc_58372_DS1.pdf",
      "authors": "stacks.cdc.gov",
      "host": "stacks.cdc.gov",
      "snippet": "85. Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am 1993;22:263–77. [PubMed: 8325286] 86. Kobayashi C, Sasaki H, Kosuge K, et al. Severe starvation hypoglycemia and congestive heart failure induced by thyroid crisis, with accidentally induced sev",
      "score": 0.46147847
    },
    {
      "number": 13,
      "title": "Research plan/Protocol for HRO: Further use of biological ...",
      "detail": "cdn.clinicaltrials.gov",
      "url": "https://cdn.clinicaltrials.gov/large-docs/03/NCT06963203/Prot_SAP_000.pdf",
      "authors": "cdn.clinicaltrials.gov",
      "host": "cdn.clinicaltrials.gov",
      "snippet": "guidelines may not always be necessary. Surgery. 2013 Nov;154(5):1009-15. doi: 10.1016/j.surg.2013.04.064. Epub 2013 Sep 26. PMID: 24075271; PMCID: PMC4167905. 12. Al Jassim A, Wallace T, Bouhabel S, et al. A retrospective cohort study: do patients with graves’ disease need to be euthyroid prior to ",
      "score": 0.41009519
    },
    {
      "number": 14,
      "title": "Thyroid Storm in a Toddler Presenting as a Febrile Seizure",
      "detail": "publications.aap.org",
      "url": "https://publications.aap.org/pediatrics/article/145/2/e20191920/68249/Thyroid-Storm-in-a-Toddler-Presenting-as-a-Febrile",
      "authors": "publications.aap.org",
      "host": "publications.aap.org",
      "snippet": "by JM Ladd · 2020 · Cited by 24 — Guidelines agree on the addition of saturated solution of potassium iodide or Lugol's iodine solution to prevent new thyroid hormone synthesis ...Read more",
      "score": 0.32136467
    },
    {
      "number": 15,
      "title": "Thyroid Storm - StatPearls - NCBI Bookshelf - NIH",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK448095",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "Esmolol, a short-acting beta-blocker, can be given in an ICU setting at a loading dose of 250 mcg/kg to 500 mcg/kg followed by 50 mcg/kg to -100 mcg/kg/minute. Cardiovascular beta-blockers like atenolol or metoprolol should be chosen for patients with reactive airway disease. If there is a contraind",
      "score": 0.82117355
    },
    {
      "number": 16,
      "title": "Amiodarone and thyroid physiology, pathophysiology, diagnosis and management☆",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC6661016",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "Thionamides are first-line therapy in the treatment of thyroid storm. As in Type I AIT, these drugs must be used at significantly higher doses than the standard regimen recommended for uncomplicated hyperthyroidism. Critically ill patients may require treatment with rectal formulations or intravenou",
      "score": 0.64182705
    },
    {
      "number": 17,
      "title": "Approach to the patient with thyroid storm - PMC",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13099200",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "## Conclusions\n\nGuideline-directed therapy for thyroid storm generally enables effective control of thyroid storm by targeting multiple pathogenic pathways through the combined use of antithyroid drugs, iodine, beta-adrenergic blockers, corticosteroids, and cholestyramine. Early recognition of the p",
      "score": 0.6347929
    },
    {
      "number": 18,
      "title": "Clinical Review and Update on the Management of Thyroid Storm - PMC",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9462913",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "Propranolol, the preferred agent, is administered at 10–40 mg three to four times per day. Atenolol dosing is 25–100 mg once to twice daily and is avoided in pregnancy. Metoprolol is dosed at 25–50 mg two to three times per day. Nadolol is dosed at 40–160 mg once daily. For severe thyroid storm requ",
      "score": 0.6337056
    },
    {
      "number": 19,
      "title": "Amiodarone Therapy: Updated Practical Insights - PMC - NIH",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11508869",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "Thyroid storm is a critical endocrine emergency with an incidence of 1–10%, more commonly affecting women and those with Graves’ disease. Mortality ranges from 10% to 30%, primarily due to multiorgan failure . Supportive therapy addresses hyperthermia, heart failure, tachyarrhythmias, and more. Beta",
      "score": 0.6334335
    },
    {
      "number": 20,
      "title": "Thyroid Storm - Endotext - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK278927",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "### Table 1.\n\nFactors That May Precipitate Thyroid Storm\n\nView in own window\n\n|  |\n\n| Infections |\n| Acute Illness such as acute myocardial infarction, stroke, congestive heart failure, trauma, etc. |\n| Non-thyroid surgery in a hyperthyroid patient |\n| Thyroid surgery in a patient poorly prepared fo",
      "score": 0.6052631
    },
    {
      "number": 21,
      "title": "Hyperthyroidism treatment: A brief review with recommendations",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/pii/S2666396125000688",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Hyperthyroidism treatment depends on cause, severity, and patient factors. • Main options are antithyroid drugs, radioactive iodine, and surgery.",
      "score": 0.2447739
    },
    {
      "number": 22,
      "title": "#1706162 Therapeutic Plasma Exchange and Thyroidectomy for Medical Refractory Thyroid Storm - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S1530891X24001642",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Skip to main contentSkip to article. 2. Case(s) Description Description\"). ## Endocrine Practice. # #1706162 Therapeutic Plasma Exchange and Thyroidectomy for Medical Refractory Thyroid Storm. Thyroid storm is a severe manifestation of thyrotoxicosis that is defined by hyperthyroidism with multi-org",
      "score": 0.7522497
    },
    {
      "number": 23,
      "title": "Thyroid Crisis - an overview | ScienceDirect Topics",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/thyroid-crisis",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Chapter\n\n## Thyroid Disorders\n\n### Thyroid Storm\n\nThyroid storm can occur with any cause of hyperthyroidism but is most reported in patients with Graves’ disease. It is rare in children but can be seen in adolescents with poor compliance with antithyroid medication or rarely as a first presentation ",
      "score": 0.60274047
    },
    {
      "number": 24,
      "title": "Thyroid Crisis - an overview",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/topics/nursing-and-health-professions/thyroid-crisis",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Thyroid storm can occur in the setting of hyperthyroidism from any cause but most frequently occurs as a complication of Graves disease. Most patients will have a precipitating event such as infection or trauma that triggers a transition from stable hyperthyroidism to thyrotoxic crisis (Table 75-2).",
      "score": 0.52773094
    }
  ],
  "publishedAt": "2026-09-15T18:34:25.677297+00:00",
  "updatedAt": "2026-09-15T18:34:25.677297+00:00",
  "readingMinutes": 6,
  "slug": "thyroid-storm-treatment-sequence"
}