Thyroid Storm & Myxedema

Endocrine, Metabolic & Toxicology · ICU Decoded chapter 64 · Free in full

Cited to ATA 2016; Burch–Wartofsky score.

Key points

Thyroid storm (Burch-Wartofsky) is treated with PTU 500–1000 mg load, then 200–250 mg q4h, iodine 1 h afterwards, propranolol, and hydrocortisone — plus treat the trigger.
Myxedema coma: IV levothyroxine 200–400 mcg load ± liothyronine, hydrocortisone (coexisting adrenal crisis), passive rewarming.
Iodine must never precede a thionamide (Jod-Basedow).
With sick euthyroid, treat the illness rather than the labs.

← Insulin & Glycemic Targets · Adrenal Crisis in Critical Illness →

More in Endocrine, Metabolic & Toxicology

Part of ICU Decoded — open the interactive version.

ICU Decoded — original critical-care and internal-medicine pathways by Dr Javed Akhtar, each cited to a current guideline. For education and quick reference; verify every dose against local protocols before prescribing.

Open the app · Ward Pathways — 113 free cases · ICU Decoded chapters · Aladin Chirag bedside tools

About · Medical disclaimer · Privacy · Contact