A 34-year-old woman with a history of Graves disease is brought to the emergency department by her husband due to severe agitation, palpitations, and confusion. She recently stopped taking her prescribed antithyroid medications. Her temperature is 39.4°C (103°F), blood pressure is 158/72 mmHg, heart rate is 145/min, and respiratory rate is 24/min. Physical examination reveals a staring gaze, a diffusely enlarged and non-tender thyroid gland, and fine resting tremors in both hands. An electrocardiogram shows sinus tachycardia. The physician diagnoses a thyroid storm. Arrange the following pharmacologic interventions in the most appropriate sequential order for the acute management of this patient's condition.
- 1Intravenous propranolol
- 2Oral propylthiouracil
- 3Oral potassium iodide
Cevap
The correct sequence of pharmacologic interventions is intravenous propranolol, followed by oral propylthiouracil, and finally oral potassium iodide.
The management of thyroid storm follows a strict stepwise pharmacologic approach. First, beta-blockers like propranolol are administered to control life-threatening peripheral adrenergic effects. Second, synthesis of new thyroid hormones must be blocked using a thionamide, such as propylthiouracil, which also blocks peripheral conversion of T4 to T3. Finally, the release of preformed thyroid hormones is blocked with an iodine solution (e.g., potassium iodide). It is critical that iodine is administered at least one hour after the thionamide to prevent the iodine from being utilized as a substrate to synthesize more thyroid hormone.
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Sequential pharmacologic management of thyroid storm
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