Which medications are used in thyroid storm treatment?

Updated: Mar 16, 2020
  • Author: Madhusmita Misra, MD, MPH; Chief Editor: Robert P Hoffman, MD  more...
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Answer

Therapy is aimed at (1) ameliorating hyperadrenergic effects of thyroid hormone (TH) on peripheral tissues with use of beta-blockers (eg, propranolol, labetalol); (2) decreasing further synthesis of THs with antithyroid medications (eg, propylthiouracil [PTU], methimazole); (3) decreasing hormonal release from the thyroid, using iodides; and (4) preventing further TH secretion and peripheral conversion of T4 to T3, using glucocorticoids or iodinated radiocontrast dyes when available.

Based on evidence and frequency estimates, Rivkees and Mattison have raised significant concerns regarding the potential for severe liver disease in children due to PTU. [25] This side effect is not seen with methimazole, and current recommendations (endorsed by the Endocrine Society) are to preferentially use methimazole in the pediatric population for treatment of Graves disease. The use of PTU in conditions of thyroid storm was not specifically addressed; however, the use of PTU may be preferred in this setting because of the ability of this drug to inhibit conversion of T4 to T3.

Of note, one retrospective chart review from Japan has reported a higher risk of mortality in patients receiving non-selective bea-blockers compared with selective beta-blockers [20] .


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