Wednesday October 04, 2006


Q; You have admitted a patient with thyroid storm. You wrote all orders including IVF, tylenol (aspirin is relatively contraindicated for control of pyrexia in thyroid storm), propranolol, hydrocortisone, propyl thiouracil (PTU)and order for oral potassium iodide one hour after administration of PTU (Yes ! you have to wait one hour to give iodide after PTU or Methimazole) . You received call from pharmacy that patient has documented allergy to iodine in previous medical record. What's your next option instead of iodine ?


A; In patients allergic to iodine, you may use lithium carbonate to reduce secretion of pre-formed thyroid hormone. Start dose with 300 mg PO every 6 hours and follow level closely to keep at 1 meq/L.