Thyroid storm occurring alongside acute congestive heart failure at Killip class III or IV is among the most haemodynamically demanding presentations of thyrotoxic crisis, requiring immediate, parallel management of both conditions.
Management at Killip class III–IV involves respiratory support measures — including noninvasive positive-pressure ventilation where the patient's status warrants it — alongside intravenous cardiac interventions addressing multiple simultaneous haemodynamic priorities, with specific choices determined by the arrhythmias and blood pressure findings present.
The full protocol specifies the complete drug selection, decision criteria, and sequencing — access it below.Hemodynamic monitoring using a Swan-Ganz catheter is recommended for patients with acute congestive heart failure classified as Killip class ≥III.
Respiratory management should include noninvasive positive-pressure ventilation (NIPPV) or artificial respiration by intratracheal intubation if the patient's respiratory status has not improved with oxygen administration.
Furosemide (intravenous), nitrate (sublingual or intravenous), and/or carperitide (intravenous) should be administered.
Beta-AAs are used for the treatment of tachycardia.
When atrial fibrillation is present, digitalis is used simultaneously.
Calcium channel blockers (intravenous) should be considered if hypertension is present.
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