Thyroid Storm

Question 1

What is thyroid storm?

Answer 1

A rare, life-threatening exacerbation of thyrotoxicosis with severe systemic decompensation

Question 2

Is thyroid storm usually the first presentation of hyperthyroidism?

Answer 2

No, it usually occurs in patients with established thyrotoxicosis

Question 3

Does iatrogenic thyroxine excess typically cause thyroid storm?

Answer 3

No

Question 4

What types of events commonly precipitate thyroid storm?

Answer 4

Surgery, trauma, infection, or acute iodine load

Question 5

Which imaging-related exposure can precipitate thyroid storm?

Answer 5

Iodinated contrast media (e.g. CT contrast)

Question 6

What core physiological system failure underlies thyroid storm?

Answer 6

Exaggerated response to excess thyroid hormone causing hypermetabolic state

Question 7

What temperature finding strongly suggests thyroid storm?

Answer 7

Fever > 38.5°C

Question 8

What cardiovascular signs are typical of thyroid storm?

Answer 8

Severe tachycardia, hypertension, heart failure, arrhythmias

Question 9

What neurological features suggest thyroid storm rather than uncomplicated thyrotoxicosis?

Answer 9

Confusion, agitation, delirium, reduced consciousness

Question 10

What gastrointestinal symptoms are commonly seen in thyroid storm?

Answer 10

Nausea, vomiting, diarrhoea

Question 11

What liver abnormalities may be seen in thyroid storm?

Answer 11

Abnormal LFTs and jaundice

Question 12

What is the immediate priority in managing thyroid storm?

Answer 12

Supportive and symptomatic treatment

Question 13

Which antipyretic is safe to use in thyroid storm?

Answer 13

Paracetamol

Question 14

Why should aspirin be avoided in thyroid storm?

Answer 14

It displaces thyroid hormone from binding proteins, worsening thyrotoxicosis

Question 15

Why are beta-blockers essential in thyroid storm management?

Answer 15

They block peripheral effects of thyroid hormone

Question 16

Which beta-blocker is typically used in thyroid storm?

Answer 16

IV propranolol

Question 17

What additional benefit does propranolol have beyond rate control?

Answer 17

It reduces peripheral conversion of T4 to T3

Question 18

Which drugs block new thyroid hormone synthesis in thyroid storm?

Answer 18

Antithyroid drugs (methimazole or propylthiouracil)

Question 19

Which antithyroid drug also reduces peripheral T4 → T3 conversion?

Answer 19

Propylthiouracil (PTU)

Question 20

Why is iodine (e.g. Lugol’s iodine) used in thyroid storm?

Answer 20

It prevents further release of thyroid hormone from the gland

Question 21

When should iodine be given relative to antithyroid drugs?

Answer 21

After antithyroid drugs (to avoid stimulating hormone synthesis)

Question 22

Why are glucocorticoids used in thyroid storm?

Answer 22

They reduce peripheral conversion of T4 to T3 and treat relative adrenal insufficiency

Question 23

Which glucocorticoids are commonly used in thyroid storm?

Answer 23

IV hydrocortisone or dexamethasone

Question 24

What non-endocrine issue must always be treated alongside thyroid storm?

Answer 24

The precipitating cause (e.g. infection, trauma)