Which medications in the drug class Antithyroids are used in the treatment of Thyroid Storm?

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

Antithyroids

These agents belong to the thioureylene (thionamide) class and inhibit synthesis of THs within 1-2 hours. They have no effect on decreasing the release of preformed THs.

Propylthiouracil (PTU, Propyl-Thyracil)

DOC that inhibits synthesis of TH by preventing organification and trapping of iodide to iodine and by inhibiting coupling of iodotyrosines; also inhibits peripheral conversion of T4 to T3, an important component of management.

Comatose patients may require administration via NG tube because the agent is available solely as PO preparation; has been successfully administered PR as an enema or suppository. Very rarely, in patients who cannot take the medication PO, via NG, or PR, IV administration has been described. The IV preparation should be made by the hospital pharmacy by dissolving tablets in normal saline rendered alkaline by adding sodium hydroxide to obtain a pH of 9.25; it is essential to ensure sterility.

Methimazole (Tapazole)

Inhibits synthesis of TH by preventing organification of iodide to iodine and coupling of iodotyrosines. Although at least 10 times more potent than PTU on a weight basis, it does not inhibit peripheral conversion of T4 to T3. May be used instead of PTU in thyroid storm if iodinated radiocontrast agents are used in conjunction to prevent the conversion of T4 to T3 or if the condition is not life-threatening.

Comatose patients may require administration via NG tube because agent is available only as a PO preparation. In rare instances, it may be necessary to administer methimazole PR as an enema or suppository or IV after dissolving tablets in normal saline at a neutral pH and filtering the solution through a fine filter. PR and IV preparations should be made by the hospital pharmacy; it is essential to ensure sterility of IV preparations.


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