A 38-year-old woman with untreated Graves disease presents with high fever (40.2°C), severe tachycardia (HR 158), altered mental status, and tremor. She admits to stopping her antithyroid medication 2 weeks ago. TSH is suppressed, free T4 is markedly elevated at 32 pg/dL, and she has signs of dehydration and hypotension. Which of the following is the most appropriate initial treatment?
- A)Immediate radioactive iodine ablation
- B)High-dose levothyroxine to normalize free T4
- C)Total thyroidectomy under general anesthesia
- D)IV fluids, propranolol, PTU, iodine solution (Lugol or SSKI), and supportive careGABARITO
- E)Acetaminophen and observation for spontaneous recovery
Explicação
Thyroid storm is a life-threatening thyrotoxic crisis requiring immediate multimodal treatment: IV fluids for dehydration and cooling, propranolol to block adrenergic effects and inhibit T4→T3 conversion, PTU to inhibit thyroid hormone synthesis, and iodine so... Ver explicação completa e trilha adaptativa →