11
Table 5. Thyroid Storm: Drugs and Doses
Drug Dosage Comment
Propylthiouracil
a
500–1000 mg
load, then 250 mg
every 4 hours
• Blocks new hormone synthesis
• Blocks T
4
-to-T
3
conversion
Methimazole 60–80 mg/day • Blocks new hormone synthesis
Propranolol 60–80 mg every
4 hours
• Consider invasive monitoring in
congestive heart failure patients
• Blocks T
4
-to-T
3
conversion in high doses
• Alternate drug : esmolol infusion
Iodine (saturated
solution of
potassium iodide)
5 drops (0.25 mL
or 250 mg ) orally
every 6 hours
• Do not start until 1 hour after antithyroid
drugs
• Blocks new hormone synthesis
• Blocks thyroid hormone release
• Alternative drug : Lugol's solution
Hydrocortisone 300 mg
intravenous load,
then 100 mg every
8 hours
• May block T
4
-to-T
3
conversion
• Prophylaxis against relative adrenal
insufficiency
• Alternative drug : dexamethasone
a
May be given intravenously.
