Endocrinology and diabetes: thyroid storm treatment sequence: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Endocrinology and diabetes: thyroid storm treatment sequence

Sample item

A patient with thyroid storm has been given propranolol, propylthiouracil and hydrocortisone. Which drug is given at least an hour after the thionamide to block release of preformed hormone?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Potassium iodide

Iodide blocks release of stored thyroid hormone but can also provide substrate for new hormone, so it is given after a thionamide has blocked synthesis. Propylthiouracil, propranolol and steroids reduce peripheral conversion of T4 to T3.

Option by option

  • A. Cholestyramine

    Cholestyramine reduces enterohepatic recirculation and is only an adjunct.

  • B. Levothyroxine

    Levothyroxine is thyroid hormone and would worsen the storm.

  • C. Carbimazole

    Carbimazole is another thionamide and does not block release of stored hormone.

  • D. Potassium iodide (correct)

    Correct. Iodide inhibits hormone release and must follow the thionamide.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Potassium iodide. Iodide blocks release of stored thyroid hormone but can also provide substrate for new hormone, so it is given after a thionamide has blocked synthesis.

Why is "Cholestyramine" not the answer?

Cholestyramine reduces enterohepatic recirculation and is only an adjunct.

Why is "Levothyroxine" not the answer?

Levothyroxine is thyroid hormone and would worsen the storm.

Why is "Carbimazole" not the answer?

Carbimazole is another thionamide and does not block release of stored hormone.

What concept does this question test?

It tests Endocrinology and diabetes: thyroid storm treatment sequence in General Medicine. Propylthiouracil, propranolol and steroids reduce peripheral conversion of T4 to T3.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology and diabetes: thyroid storm treatment sequence?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.