Thyroid Storm & Myxedema

Endocrine, Metabolic & Toxicology · ICU Decoded chapter 64 · Locked — free with a referral

By Dr Javed Akhtar · Last reviewed 3 October 2026

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.

Investigations

Thyroid storm

First tests: TSH, free T4 and T3, 12-lead ECG, Sodium, potassium, bicarbonate, urea and creatinine, Liver biochemistry, Blood glucose.

Only if indicated: Blood cultures, Bedside echocardiography.

Repeat monitoring: TSH, free T4 and T3.

Myxedema coma

First tests: TSH and free T4, Blood glucose, Sodium, potassium, bicarbonate, urea and creatinine, Arterial blood gas, 12-lead ECG.

Only if indicated: Cortisol sample, Blood cultures.

Repeat monitoring: TSH and free T4.

Locked

Treatment orders with doses
Why and when to send each test

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