What medication is used to inhibit the release of T4 and T3 in a thyroid storm?

In the context of a thyroid storm, the goal is to rapidly inhibit the production and release of thyroid hormones T4 (thyroxine) and T3 (triiodothyronine). Propylthiouracil (PTU) is a thioamide that is effective in treating hyperthyroidism, including thyroid storm, by inhibiting the enzyme thyroperoxidase, which plays a crucial role in the synthesis of thyroid hormones.

Administering a high initial dose of PTU, such as 1000 mg orally, is standard in the management of thyroid storm to achieve a rapid drop in circulating thyroid hormones. The subsequent dosing of 200 mg every 6 hours helps to maintain therapeutic levels and continues to block hormone synthesis effectively.

In contrast, levothyroxine is a synthetic form of T4 and would not be appropriate in the treatment of thyroid storm, as it would exacerbate hyperthyroidism. Carbimazole, while also a thioamide like PTU, is not typically administered at such a high initial dose or as frequently in acute settings. Dexamethasone can help with symptoms and has a modest effect on the peripheral conversion of T4 to T3, but it does not directly inhibit the