treatment of thyroid crisis
Last reviewed 01/2018
Seek expert adviceThe 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.