A 45-year-old woman undergoes subtotal thyroidectomy for Graves' disease. Two hours postoperatively she develops a temperature of 40 degrees Celsius, a pulse of 150 bpm, restlessness and vomiting. There is no neck swelling or stridor. Which is the FIRST priority in management?

• A Intravenous propranolol or esmolol ✓
• B Oral carbimazole
• C Intravenous hydrocortisone as sole therapy
• D Immediate re-exploration of the neck

Explanation

This is thyroid storm, and the immediate threat is the adrenergic cardiovascular crisis, so beta blockade with intravenous propranolol or esmolol comes first to control tachycardia and arrhythmia. Antithyroid drugs such as carbimazole are given promptly afterwards, followed by iodine at least one hour later to block hormone release, with corticosteroids and cooling as supportive measures. Re-exploration is indicated for compressive haematoma, which presents with neck swelling, pain and airway compromise rather than hyperpyrexia.

Reference: Williams Textbook of Endocrinology, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.