This handout is for thyroid storm. Your care team identified this based on: hyperpyrexia + sinus tach/af + ams.
Other reasons your team may use this plan: suppressed tsh + markedly elevated ft4/ft3; known graves with infection / surgery / iodine load.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| propylthiouracil | 500–1000 mg PO/NG load → 250 mg PO/NG q4h | PO/NG | q4h | ATA 2016 — preferred in storm because also blocks T4→T3 peripheral conversion; 1st trimester pregnancy preferred over methimazole (teratogenicity); switch to methimazole after storm resolves due to PTU hepatotoxicity |
| methimazole | 60–80 mg/day in divided doses (e.g., 20 mg PO q6h) | PO/NG | q6–8h | ATA 2016 — alternative; preferred long-term (less hepatotoxic); does NOT block T4→T3 conversion |
Plan: Thyroid storm — 5-pillar (block synthesis → block release → block periphery → cool → support)
Call 911 or go to the nearest emergency room right away if you have:
Endocrinology + thyroid ultrasound; plan definitive therapy (RAI or thyroidectomy after 4-8 wk antithyroid stabilization); ophthalmopathy assessment; agranulocytosis education
Guideline: 2016 ATA Hyperthyroidism Guideline + 2016 JTA/JES Thyroid Storm Guidelines + 2023 ETA Hyperthyroidism + Burch-Wartofsky 1993