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Cardiovascular collapse associated with beta blockade in thyroid storm
R Dalan1, Melvin K Leow, Melvin C Leow
1Department of Endocrinology, Tan Tock Seng Hospital, Singapore. rinkoo99@yahoo.com
Summary
Oral propranolol use in thyroid storm patients with low cardiac output may precipitate cardiorespiratory arrest. Consider ultra-short-acting beta-blockers like esmolol cautiously as a safer alternative.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Thyroid storm is a life-threatening condition characterized by exaggerated hyperthyroid symptoms.
- Management often involves beta-blockers to control adrenergic symptoms.
Observation:
- Three cases of thyroid storm patients experienced sudden cardiorespiratory arrest shortly after oral propranolol administration.
- These events occurred within hours to 12 hours of initiating propranolol therapy.
Findings:
- Oral propranolol may pose a risk for cardiorespiratory arrest in select thyroid storm patients, particularly those with low-output cardiac failure.
- The timing of arrest suggests a potential adverse reaction to oral beta-blocker therapy in this critical state.
Implications:
- Clinicians should exercise caution when prescribing oral propranolol to thyroid storm patients with compromised cardiac function.
- Intravenous esmolol, an ultra-short-acting beta-blocker, may be a safer alternative when beta-blockade is necessary, with careful monitoring.
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