Weathering the storm: beta-blockade and the potential for disaster in severe hyperthyroidism

Some patients with advanced thyrotoxicosis have occult cardiac dysfunction. The use of long-acting beta-blockers, traditional in the management of thyrotoxicosis, may have disastrous consequences in this setting. The following report documents the cardiovascular collapse and asystolic arrest of a patient with hyperthyroidism when treated with sotolol. Though the patient was successfully resuscitated, the long duration of action of sotolol necessitated prolonged inotropic and vasopressor support. A shorter acting beta-blocker, such as esmolol, theoretically may be a safer option.