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Treatment of thyroid crisis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The condition is an emergency requiring prompt intervention.

General measures:

  • i.v. fluids
  • antipyretics
  • antibiotics if infection suspected

Specific measures:

  • high dose carbimazole - 45-60 mg/day - possibly by a nasogastric tube
  • potassium iodide 200 mg i.v. over 1 hr, then 100 mg orally od - to block the release of thyroid hormones.
  • propranolol 80 mg by mouth or 1-5 mg i.v. qds
  • the radiographic contrast agent ipanoic acid or ipodate sodium (1g a day by mouth) can also be used - inhibits the conversion of thyroxine to triidothyronine; also the iodine released as a result of the metabolism of these agents has an anti-thyroid effect.
  • dexamethasone 2 mg qds
  • anxiety may require sedation with chlorpromazine 25-50 mg 6-hourly

Long term surveillance of thyroid status is indicated.

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