A patient with Graves' disease is hypertensive, agitated, and pyretic at 103 F. The electrocardiogram (ECG) shows cardiac arrhythmia. Which of the following medication(s) would the nurse expect to administer for this condition?


• Thyroid storm is a rare, life-threatening condition characterized by severe clinical manifestations of thyrotoxicosis, fever, tachycardia (usually atrial in origin), and sweating. Some patients may also have abdominal pain with nausea, vomiting, and liver dysfunction secondary to hepatic congestion, hypoperfusion, and excess thyroid hormone. 

• The immediate goals when treating thyroid storm are to decrease thyroid hormone synthesis, prevent thyroid hormone release, decrease the action of circulating thyroid hormone to reduce heart rate, and to treat the condition that brought on the thyroid storm.

• Treatment is based on the five ‘Bs’: Block synthesis (i.e. antithyroid drugs); Block release (i.e. iodine); Block T4 into T3 conversion (i.e. high-dose carbimazole, propranolol, and corticosteroids); Beta blocker (propranolol again); and Block enterohepatic circulation (i.e. cholestyramine).

• Despite hyperpyrexia, cooling should be done without the use of aspirin which increases free TH.

• Ethanol injection is administered to toxic adenomas, and is not given for thyroid storm.

• Synthetic thyroxine is used to treat hypothyroidism and would make this patient much worse.

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