In thyroid storm

Blockers are usually used as adjunctive therapy with antithyroid drugs, RAI, or iodides when treating Graves disease or toxic nodules in preparation for surgery or in thyroid storm. /3-Blockers are primary therapy only for thyroiditis and iodine-induced hyperthyroidism. 

Corticosteroids are generally recommended, but there is no convincing evidence of adrenocortical insufficiency in thyroid storm their benefits may be attributed to their antipyretic action and stabilization of blood pressure. 

Iodine is used in thyroid storm, hyperthyroidism, preoperatively before thyroidectomy and prophylaxis of endemic goitre. Iodine is also useful as antiseptic and in expectorants. 

A typical starting dose of propylthiouracil is 100 mg every 8 hours or 150 mg every 12 hours. When doses >300 mg/day are needed in severely hyperthyroid patients, the drug should be administered at least every 8 hours. In thyroid storm, propylthiouracil is preferred due to its inhibition of peripheral conversion ofT to T doses of200-400 mg every 4 hours are typically employed. 

Propranolol or atenolol can reduce the heart rate and other sympathetic manifesiutums of hyperthyroidism and provide partial relief of symptoms until full control is achieved with carbimazole. It is useful in the preoperaiivc prepaniiion of patients undergoing thyroidectomy. Propranolol is also u.sed together with hydrocortisone, iodine and car-himazole in thyroid storm. ... 

Jl. Jacobs, H. S., Madcie, D. B., Eastman, C. J., Ellis, S. M., Ekins, R. F., and McHardy-Young, S., Total and free triiodothyronine and thyroxine levels in thyroid storm and recurrent hyperthyroidism. Lancet 2, 236-238 (1973). 

---