NCLEX-PN® ExaminationPhysiological AdaptationHard
A client is exhibiting symptoms of thyroid storm, including a temperature of 104.2°F (40.1°C), heart rate of 160 bpm, profuse sweating, and altered mental status. The nurse anticipates administering which medication as a priority to block the synthesis of thyroid hormones?
- APropranolol
- BIodine solution (Lugol's solution)
- CHydrocortisone
- DPropylthiouracil (PTU)
Show answer & explanationAnswer & explanation
Correct answer: D. Propylthiouracil (PTU)
Propylthiouracil (PTU) is the priority medication in thyroid storm to block the synthesis of new thyroid hormones and also inhibits peripheral conversion of T4 to T3. Propranolol manages symptoms, iodine blocks hormone release (after PTU), and hydrocortisone addresses adrenal insufficiency and supports blood pressure.
Why the other options are wrong
- A. Propranolol (beta-blocker) manages symptoms like tachycardia and tremors but does not block hormone synthesis.
- B. Iodine solution blocks the release of thyroid hormones, but it should be given at least an hour AFTER PTU to prevent the iodine from being used to synthesize more hormones.
- C. Hydrocortisone is used to treat potential adrenal insufficiency and support blood pressure, but it does not directly block thyroid hormone synthesis.
Thyroid Storm Management
Thyroid storm is a life-threatening hypermetabolic state requiring urgent treatment to block thyroid hormone synthesis, block hormone release, manage symptoms, and provide supportive care.
- PTU is preferred over methimazole in thyroid storm due to its additional effect of blocking T4 to T3 conversion.
- Iodine solution must be given after PTU.
- Beta-blockers control cardiovascular symptoms.
Memory trick: PTU Prevents Production, Propranolol Protects.