Red flags
- Coma, seizure, cardiac arrest
- High-output HF
- Hyperthermia >40 °C
First steps
- ABCDE + IV access
- Propranolol 40-80 mg PO or 1-2 mg IV q10 min
- Propylthiouracil 500-1000 mg loading then 250 mg q4h
- Hydrocortisone 100 mg IV q6h
Key investigations
- TSH, free T4/T3
- CBC, U&E, LFT, glucose, ABG, ECG
- Burch-Wartofsky score
Differentials
- Sepsis, sympathomimetic OD, phaeochromocytoma
Initial management
- Lugol iodine 8 drops q6h 1 h AFTER PTU
- Cooling, IV fluids
- Treat trigger (infection, MI, surgery)
- Definitive: radio-iodine or surgery after control
Referral
- Endocrinology + ICU
AI clinical assessment
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