A 29-year-old woman is admitted to the intensive care unit with severe agitation, profuse diaphoresis, and a temperature of 39.8°C (103.6°F). Her heart rate is 158/min, blood pressure is 152/74 mm Hg, and respiratory rate is 24/min. Physical examination reveals a diffusely enlarged thyroid gland, a fine resting tremor, and hyperreflexia. She has a history of Graves disease but has been nonadherent to medical therapy for the past eight months. A diagnosis of thyroid storm is established.
Arrange the following pharmacologic interventions in the most appropriate chronological order of administration to safely and effectively manage her condition.
- 1Intravenous propranolol
- 2Oral propylthiouracil
- 3Oral potassium iodide
Cevap
The correct sequence is: 1) Intravenous propranolol, 2) Oral propylthiouracil, 3) Oral potassium iodide.
The precise chronological protocol for thyroid storm is dictated by physiological mechanisms. Intravenous propranolol is given immediately for rapid mitigation of life-threatening sympathetic hyperactivity and to decrease peripheral T4 to T3 conversion. Oral propylthiouracil is then given to inhibit thyroid peroxidase, halting the synthesis of new hormone. Finally, oral potassium iodide is given at least one hour later to trigger the Wolff-Chaikoff effect, blocking the release of pre-stored hormone from the gland.
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Anahtar Kavram
In the management of thyroid storm, sympathetic blockade (propranolol) is the immediate priority, followed by blocking hormone synthesis (propylthiouracil), which must strictly precede blocking hormone release (potassium iodide) to avoid paradoxically fueling hormone production.
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