Thyroid disease in pregnancy: A review of diagnosis, complications and management

Table 4 Six steps for treatment of thyroid storm

1 Admit to intensive care unit	IV fluids and watch electrolytes
2 Tylenol 650 mg q6 h	For hyperpyrexia
3 Loading dose of 1000 mg PTU orally then 200 mg orally q6 h; alternate dosing 300 mg PTU q6 h	Will block synthesis of T3 and T4
4 Iodine supplementation 10 drops of Lugol’s solution q8 h OR 1 g sodium Iodide IV q8-12 h Iodine allergy use lithium carbonate 300 mg PO q6 h	Blocks release of hormone from the thyroid gland
5 Hydrocortisone 50-80 mg q8 h for 3 doses OR Dexamethasone 2 mg IV q6 h for 4 doses	To block peripheral conversion of T4 to T3
6 Beta blocker Labetolol 300 mg TID may increase to a max dose of 800 mg TID but watch blood pressure	To control the tachycardia – use cautiously in heart failure

PTU: Propylthiouracil; TID: Three times a day.