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● During a thyroid storm, reduce the hormone production with propylthiouracil (loading dose 1000 mg, therafter 250 mg every 4 hours) and methimazole (80 mg/d), inhibit hormone release with lithium carbonate (initially 300 mg every 6 hours) and the tyroxine to triiodothyronine conversion with prednisolone and propranolol. Reduce fever with paracetamol and tachycardia/-arrhythmia with propranolol. Replace fluid lost via fever and sweating. Prevent desiccation-induced thrombosis with heparin. If insufficient and plasmapheresis is unavailable, consider early thyreidectomy. Otherwise treat the underlying cause (usually Graves disease or thyroid autonomy, frequently accompanied by a precipitating factor such as excessive iodide exposure, surgery, labor, or infection).
● Patients in myxedema coma require mechanical ventilation and blankets to treat hypothermia. Correct hyponatremia and hypotension with appropriate fluids and glucocorticoids. Under ECG monitoring give i.v. levotyroxine (300 µg/d1, 100 µg/d2, 50 µg on day 3 and following), in combination with triiodothyronine (10 µg every 12 hours), as peripheral conversion may be impaired. Identify and treat the precipitating factor (typically infection, congestive heart failure, cerebrovascular injury). 
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