ATA Thyroid Storm 2016 — Guidelines for the Management of Hyperthyroidism, Thyrotoxicosis, and Thyroid Storm

Thyroid storm requires immediate multi-targeted ICU therapy: (1) Beta-blocker (propranolol 60-80 mg PO q4h or esmolol infusion), (2) Thionamide (PTU 200 mg q4h or methimazole 20 mg q6h) to block new hormone synthesis, (3) Inorganic iodine (SSKI 5 drops q6h or Lugol solution) administered AT LEAST 1 HOUR AFTER thionamide to prevent Wolff-Chaikoff escape, (4) IV hydrocortisone (100 mg q8h) to reduce peripheral T4-to-T3 conversion and treat adrenal insufficiency, (5) Bile acid sequestrants (cholestyramine) to block enterohepatic recirculation.