Name three hallmark features of thyroid storm and the immediate management priorities.

• A. High fever, tachycardia, agitation; immediate management includes beta-blockade (eg propranolol), antithyroid drug (methimazole or PTU), iodine solution after antithyroid drug, and hydrocortisone or dexamethasone; supportive care.
• B. Low fever, bradycardia; calcium and thiazide diuretics.
• C. Moderate fever; no treatment needed.
• D. Hypothyroid features; treat with levothyroxine.

Answer: (D)

Thyroid storm is a life-threatening hyperthyroid crisis marked by runaway sympathetic activation and rapid deterioration of multiple organ systems. The three hallmark features to recognize are very high fever, tachycardia, and agitation or delirium. These reflect the extreme excess of thyroid hormone affecting metabolism, heart rate, and mental status.

Immediate management aims to rapidly blunt thyroid hormone effects and stabilize the patient. Start with beta-blockade to control the adrenergic overdrive and help reduce peripheral conversion of T4 to T3. Use an antithyroid drug to stop new hormone synthesis. After giving the antithyroid agent, administer iodine solution to inhibit release of stored thyroid hormone. Add glucocorticoids to decrease T4 to T3 conversion and to cover potential adrenal insufficiency. Provide aggressive supportive care: cooling measures, IV fluids, electrolyte and glucose management, oxygen as needed, and treatment of any precipitating illness.

Other options don’t fit: bradycardia with calcium and thiazides doesn’t reflect the hyperthyroid storm; moderate fever with no treatment misses the urgency; hypothyroid features with levothyroxine are the opposite of a thyroid storm.