Diagnosis

Management

1. Block New Production – Methimazole or PTU – While there has been much debate in the past over the use of the antithyroids PTU and methimazole, current literature suggests PTU to be considered second-line therapy except in people who are allergic, intolerant to methimazole, or pregnant. No current literature suggests better efficacy with PTU and the increased risk for adverse events make methimazole the preferred agent in hyperthyroid states.
2. Block Thyroid Hormone Release – Lugol’s Soulution or Sodium Iodide
3. Treat Volume Loss – Even in the setting of seeming heart failure, they may need fluids as the heart failure is high-output.
4. Treat Sympathetic Surge – Propranolol
5. Block Peripheral Conversion and Shield from Adrenal Insufficiency – Dexamethasone or Hydrocortisone
6. Temperature Regulation – Do not aggressively cool these patients; this is contraindicated because it can lead to further vasoconstriction
7. Fix Precipitating Event/Treat Infection – Look carefully, treat aggressively