Thyroid storm is a life-threatening condition of the hyperthyroid state. 26 It most commonly occurs in patients with Graves' disease but may also occur in those with multinodular goiter or toxic adenoma. 27 It is treated by correcting the hyperthyroidism and treating the precipitating events. 26 Correction of the hyperthyroid state involves using drugs such as propylthiouracil or methimazole (Tapazole), beta blockers or corticosteroids, which decrease the peripheral effects of thyroid hormone and the conversion of thyroxine (T 4 ) to the more potent triiodothyronine (T 3 ). 22 , 26 Dexamethasone can be used for that purpose, at a dosage of 2 mg intravenously every six hours, and can eventually can be switched to an oral dosage of 2 mg every six hours. 28
Side effects are minimized by taking the lowest doses possible (that still yields positive results) and following doctor's orders. It is important to avoid self-regulation of the dosage, either by adding more or stopping the drug without a schedule. After prolonged use, steroids must be gradually reduced to permit the adrenal glands to resume natural cortisol production. Eliminating doses too quickly can result in glucocorticoid withdrawal symptoms, worsening of underlying inflammatory disease (rebound effect), or rarely, adrenal crisis (a life-threatening state caused by insufficient levels of adrenal steroids).