Thyroid storm arising from destructive thyroiditis—whether subacute thyroiditis or drug-induced thyroiditis—is a specific clinical scenario where the origin of excess thyroid hormone shapes which treatments are safe and which are not.

Clinical Scenario

This protocol covers thyroid storm caused by destructive thyroiditis, including subacute thyroiditis and drug-induced thyroiditis. In this setting, thyroid hormone enters the circulation through destructive release from the gland rather than through synthesis, which has a direct consequence for treatment selection.

⚠ Antithyroid drugs are contraindicated in this scenario

Treatment Overview (partial)

Corticosteroid therapy is a cornerstone of management in this setting, combined with measures to control heart rate and reduce high fever. The specific agents, selection criteria, and full sequencing are available in the complete protocol.

References

In cases of thyroid storm caused by destructive thyroiditis, such as subacute thyroiditis or drug-induced thyroiditis, administration of ATDs is contraindicated because the patient is unnecessarily exposed to the risk of the adverse effects of ATDs, which are not effective against the destructive release of thyroid hormones stored before the onset of thyroiditis.
Corticosteroids (300 mg/day hydrocortisone or 8 mg/day dexamethasone) should be administered to patients with thyroid storm regardless of its origin.
Beta1-selective AAs (landiolol, esmolol (intravenous), or bisoprolol (oral)) should be selected as the first choice of treatment for tachycardia in thyroid storm.
Aggressive cooling with acetaminophen and mechanical cooling with cooling blankets or ice packs should be performed for thyroid storm patients with high fever.
Heart rate should be controlled to ≤130 bpm when beta-AAs are used.

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Treatment of Thyroid Storm Caused by Destructive Thyroiditis (Subacute or Drug-Induced)