Propanolol Administration in a Patient with Thyroid Storm

Letters18 April 2000Propanolol Administration in a Patient with Thyroid StormHiroshi Ashikaga, MD, Ricardo Abreu, MD, and Roslyn F. Schneider, MDHiroshi Ashikaga, MDBeth Israel Medical Center; New York, NY 10003 (Ashikaga)Beth Israel Medical Center; New York, NY 10003 (Abreu)Beth Israel Medical Center; New York, NY 10003 (Schneider), Ricardo Abreu, MDBeth Israel Medical Center; New York, NY 10003 (Ashikaga)Beth Israel Medical Center; New York, NY 10003 (Abreu)Beth Israel Medical Center; New York, NY 10003 (Schneider), and Roslyn F. Schneider, MDBeth Israel Medical Center; New York, NY 10003 (Ashikaga)Beth Israel Medical Center; New York, NY 10003 (Abreu)Beth Israel Medical Center; New York, NY 10003 (Schneider)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-132-8-200004180-00029 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Four weeks after stopping oral methimazole therapy, a 50-year-old woman with Graves disease presented with restlessness, palpitations, diaphoresis, and vomiting, without signs of heart failure. The thyroid-stimulating hormone level was undetectable, and free thyroxine and triiodothyronine levels were markedly elevated. Propranolol, saturated solution of potassium iodine, propylthiouracil, and hydrocortisone were administered. Hypotension developed 3 to 4 hours after each propranolol dose; this therapy was then discontinued, and the blood pressure was supported with norepinephrine (21 µg/min). Jugular venous distention, bibasilar crackles, an S3 gallop, and severe lactic acidosis (lactic acid level, 10.9 mmol/L [normal range, 0.5 to ...References1. Bilezikian JP, Loeb JN. The influence of hyperthyroidism and hypothyroidism on α-β-adrenergic receptor systems and adrenergic responsiveness. Endocrine Rev. 1983;4:378-88. CrossrefMedlineGoogle Scholar2. Karlberg BE, Henriksson KG, Andersson RG. Cyclic adenosine 3′,5′-monophosphate concentration in plasma, adipose tissue and skeletal muscle in normal subjects and in patients with hyper- and hypothyroidism. J Clin Endocrinol Metab. 1974;39:96-101. CrossrefMedlineGoogle Scholar3. Coulombe P, Dussault JH, Walker P. Catecholamine metabolism in thyroid diseases. II. Norepinephrine secretion rate in hyperthyroidism and hypothyroidism. J Clin Endocrinol Metab. 1977;44:1185-9. CrossrefMedlineGoogle Scholar4. Hammond HK, White FC, Buxton IL, Saltzstein P, Brunton LL, Longhurst JC. Increased myocardial β-receptors and adrenergic responses in hyperthyroid pigs. Am J Physiol. 1987;252:H283-290. MedlineGoogle Scholar5. Forfar JC, Muir AL, Sawers SA, Toft AD. Abnormal left ventricular function in hyperthyroidism. N Engl J Med. 1982;307:1165-70. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Hiroshi Ashikaga, MD; Ricardo Abreu, MD; Roslyn F. Schneider, MDAffiliations: Beth Israel Medical Center; New York, NY 10003 (Ashikaga)Beth Israel Medical Center; New York, NY 10003 (Abreu)Beth Israel Medical Center; New York, NY 10003 (Schneider) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCorrection: Propranolol and Thyroid Storm Metrics Cited byAdvantages of monitoring rT3 and dividing LT3 dose in the treatment of consumptive hypothyroidism associated with infantile hepatic hemangiomaSevere Thyrotoxicosis and Thyroid StormEndocrine EmergenciesPropranolol-Induced Circulatory Collapse in a Patient With Thyroid Crisis and Underlying Thyrocardiac Disease: A Word of CautionEndocrine EmergenciesThyroid Gland DisordersEndocrine DisordersThyroid DisordersWeathering the storm: Beta-blockade and the potential for disaster in severe hyperthyroidismCorrection: Propranolol and Thyroid Storm 18 April 2000Volume 132, Issue 8Page: 681-682KeywordsBlood pressureLactic acidNorepinephrineOxygenStormsThyroidThyroid-stimulating hormoneThyroxineTriiodothyronineVomiting ePublished: 15 August 2000 Issue Published: 18 April 2000 Copyright & PermissionsCopyright © 2000 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...