McMaster Textbook of Internal Medicine

Treatment of thyroid storm

2020-11-13

Leonard Wartofsky

Recorded at the 5th McMaster International Review Course in Internal Medicine (MIRCIM).

Dr Leonard Wartofsky is a professor of medicine at Georgetown University Hospital, chairman emeritus of the Department of Medicine at the Washington Hospital Center, and past president of the American Thyroid Association and the Endocrine Society.

How to treat thyroid storm?

Leonard Wartofsky, MD, MPH: We treat thyroid storm with a multipronged approach to therapy, starting with inhibiting new synthesis of thyroid hormone with propylthiouracil (PTU) or Tapazole (methimazole/thiamazole). Secondly, inhibiting the release of hormone with iodine or lithium carbonate. Treating the thyroid hormone levels that are elevated in the peripheral blood, which can be done by dialysis, plasmapheresis, or charcoal hemadsorption columns—percolating blood through a column. And treating whatever the underlying illness: infection, sometimes it was surgery, or labor and delivery. So, [we use] the customary therapy for whatever was going on to restore normal homeostasis and compensation.

See also

Management of severe hypothyroidism and myxedema coma What is the appropriate treatment in patients with severe hypothyroidism and myxedema coma? What thyroid hormones should be administered (T₄ and T₃ administered together or separately)? What dosing should be used?
Changes in the management of type 2 diabetes (2018 consensus) What is the most important change in the management of type 2 diabetes according to the 2018 consensus report by the American Diabetes Association (ADA) and the European Association of the Study of Diabetes (EASD)?
Inhibition of new thyroid hormone synthesis in hyperthyroidism What are the treatment options for inhibiting the synthesis and secretion of new hormones in severe hyperthyroidism? How much time is needed to see clinical outcomes?
Accuracy of the Burch-Wartofsky Point Scale Why is the Burch-Wartofsky Point Scale based only on clinical and physical criteria? How accurate are the estimates?
Thyroid emergencies A lecture by Dr Leonard Wartofsky, from Georgetown University, USA, delivered at McMaster International Review Course in Internal Medicine (MIRCIM) in May 2019.
Management of patients with thyroid emergencies in the ICU Should patients with thyroid emergencies (myxedema coma, thyroid storm) be treated in the intensive care unit (ICU)? What parameters and laboratory tests should be monitored?
Age threshold for obesity treatment Can we define an age limit over which treatment of obesity is no longer beneficial?

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