Eight hours after subtotal thyroidectomy for Graves disease, a 26-year-old woman develops fever of 40 degrees C, pulse of 150 per minute, restlessness, and vomiting. Which sequence of drug therapy is correct?

• A Propranolol, then potassium iodide, then propylthiouracil
• B Radioactive iodine immediately, then beta blockade
• C Potassium iodide first, then carbimazole, then propranolol
• D Propylthiouracil first, followed by iodine at least one hour later ✓

Explanation

In thyroid storm, propylthiouracil must be given first to block new hormone synthesis, and iodine is delayed by at least one hour because iodine given earlier provides substrate for synthesis of additional hormone and can worsen the storm. Propranolol is added early for adrenergic control but does not replace this sequence. Radioactive iodine is absolutely contraindicated in storm, which kills option B outright.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.