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Hyperthyroidism & Thyroid Storm

Also known as: thyrotoxicosis · overactive thyroid · Graves disease · thyroid storm

Excess thyroid hormone — weight loss, palpitations, tremor, heat intolerance, anxiety and diarrhoea. Graves' disease is the commonest cause; thyroid storm is a life-threatening emergency.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

More common in women; causes include Graves' disease (autoimmune), a toxic nodule or multinodular goitre, thyroiditis, and excess iodine or thyroxine.

Red flags — escalate / refer

Thyroid storm — high fever, severe tachycardia/AF, agitation or delirium, heart failure and GI dysfunction → emergency.
New atrial fibrillation or heart failure from thyrotoxicosis.
Sore throat + fever on an antithyroid drug → stop it and check FBC (agranulocytosis).

Work-up / diagnosis

1A suppressed TSH with raised free T4/T3 confirms thyrotoxicosis.
2Establish the cause: TSH-receptor antibodies (Graves'), and a thyroid uptake scan where needed.
3ECG for atrial fibrillation.

Management — overview

Control symptoms with a beta-blocker (e.g. propranolol) for tremor and palpitations.
Start an antithyroid drug (carbimazole; propylthiouracil is preferred in the first trimester of pregnancy and in storm).
Plan definitive treatment for Graves'/nodular disease: radioactive iodine or surgery.
Thyroid storm: antithyroid drug (PTU), beta-blocker, iodine (given AFTER the antithyroid drug), corticosteroids, cooling and supportive care — and treat the trigger.

In-depthFull dosing & advanced protocol

Drug dosing

Carbimazole (antithyroid)

First-line control (non-pregnant)

Adult dose: Titration or block-and-replace regimen, adjusted to thyroid function
Route: Oral

Caution: Warn about agranulocytosis; teratogenic in the first trimester.

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Propranolol (beta-blocker)

Symptom relief; also used in storm

Adult dose: Titrate for symptom control
Route: Oral / IV

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Propylthiouracil (PTU)

First-trimester pregnancy & thyroid storm

Adult dose: Per guidance
Route: Oral

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Cause, definitive therapy & storm

Differentiate Graves' from nodular disease and thyroiditis (antibodies + uptake scan) — it guides therapy.
Definitive options: radioiodine or surgery; choose by patient factors, goitre size and pregnancy plans.
Thyroid storm (e.g. high Burch-Wartofsky score): PTU → then iodine, beta-blocker, steroids, cooling and ICU support.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Carbimazole (antithyroid)

Propranolol (beta-blocker)

Propylthiouracil (PTU)

📈 Cause, definitive therapy & storm

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Carbimazole (antithyroid)

Propranolol (beta-blocker)

Propylthiouracil (PTU)

📈 Cause, definitive therapy & storm

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Cause, definitive therapy & storm

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Cause, definitive therapy & storm

References