{"id":2055,"date":"2022-01-01T17:42:00","date_gmt":"2022-01-01T17:42:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=2055"},"modified":"2025-10-01T11:40:32","modified_gmt":"2025-10-01T19:40:32","slug":"usmle-step-2-ck-question-of-the-day-thyroid-storm","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-thyroid-storm","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day: Thyroid Storm"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-thyroid-storm\/#Check_out_our_free_USMLE%C2%AE_Step_2_Ultimate_Guide\" >Check out our free&nbsp;USMLE\u00ae Step 2 Ultimate Guide!<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-thyroid-storm\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-thyroid-storm\/#A_Hydrocortisone\" >A. Hydrocortisone<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-thyroid-storm\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-thyroid-storm\/#B_Heparin\" >B. Heparin<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-thyroid-storm\/#C_Ceftriaxone\" >C. Ceftriaxone<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-thyroid-storm\/#D_Aspirin\" >D. Aspirin<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-thyroid-storm\/#E_Dantrolene\" >E. Dantrolene<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-thyroid-storm\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-thyroid-storm\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-thyroid-storm\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Here&#8217;s another USMLE\u00ae Step 2 CK Question of the Day!&nbsp;Today&#8217;s case involves a 45-year-old woman with altered mental status, nausea, vomiting, and diarrhea. Medical history is remarkable for long-standing&nbsp;Graves disease&nbsp;and&nbsp;gastroesophageal reflux disease. IV propranolol is initiated. Which additional medications should also be administered to this patient?<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 45-year-old woman presents to the emergency department due to agitation and altered mentation. The patient was in her usual state until a few hours ago when she started having severe nausea, vomiting, and diarrhea. Medical history is remarkable for long-standing&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Graves_disease\" target=\"_blank\" rel=\"noreferrer noopener\">Graves disease<\/a>&nbsp;and&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Gastroesophageal_reflux_disease_(GERD):_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">gastroesophageal reflux disease<\/a>. Last week, the patient had&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Upper_respiratory_tract_infection\" target=\"_blank\" rel=\"noreferrer noopener\">an upper respiratory infection<\/a>&nbsp;that resolved without treatment. The patient has been partially compliant in taking her medications, which include&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Proton_pump_inhibitor_(PPIs):_Nursing_Pharmacology\" target=\"_blank\" rel=\"noreferrer noopener\">omeprazole&nbsp;<\/a>and&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hyperthyroidism_medications\" target=\"_blank\" rel=\"noreferrer noopener\">propylthiouracil<\/a>. Temperature is 40\u00b0C (104.0\u00b0F), pulse is 150\/min and irregular, and blood pressure is 150\/100 mmHg. On physical examination, the patient is stuporous and her skin is moist. Laboratory tests show elevated liver enzymes, mild hyperglycemia, and leukocytosis. IV propranolol is initiated.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following additional medications should also be administered to this patient?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Hydrocortisone<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Heparin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Ceftriaxone<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Aspirin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Dantrolene<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down for the correct answer!<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Slovakia learns by Osmosis.org!\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/sxQ8Dqz_MXs?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Check_out_our_free_USMLE%C2%AE_Step_2_Ultimate_Guide\"><\/span><strong>Check out our free<a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-2\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;USMLE\u00ae Step 2 Ultimate Guide!<\/a><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Hydrocortisone\"><\/span>A. Hydrocortisone<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s see why the answer wasn&#8217;t B, C, D, or E. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Today&#8217;s incorrect answers are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Heparin\"><\/span>B. Heparin<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Anticoagulants:_Heparin\" target=\"_blank\" rel=\"noreferrer noopener\">Heparin&nbsp;<\/a>is an anticoagulant used in conditions such as&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Venous_thromboembolism:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">venous thromboembolism<\/a>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Deep_vein_thrombosis\" target=\"_blank\" rel=\"noreferrer noopener\">deep vein thrombosis<\/a>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Pulmonary_embolism\" target=\"_blank\" rel=\"noreferrer noopener\">pulmonary embolism<\/a>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Myocardial_infarction\" target=\"_blank\" rel=\"noreferrer noopener\">myocardial infarction<\/a>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Stroke:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">stroke<\/a>, or&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Transient_ischemic_attack\" target=\"_blank\" rel=\"noreferrer noopener\">transient ischemic attack<\/a>. Although some of this patient\u2019s symptoms could be explained by myocardial infarction, the presence of very high fever, diarrhea, and a long history of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Graves_disease\" target=\"_blank\" rel=\"noreferrer noopener\">Graves disease<\/a>&nbsp;favors another diagnosis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Ceftriaxone\"><\/span>C. Ceftriaxone<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Antibiotics_-_Cephalosporins:_Nursing_Pharmacology\" target=\"_blank\" rel=\"noreferrer noopener\">Ceftriaxone&nbsp;<\/a>is used to treat bacterial infections caused by gram-negative or gram-positive bacteria. This patient had a viral&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Upper_respiratory_tract_infection\" target=\"_blank\" rel=\"noreferrer noopener\">upper respiratory infection<\/a>&nbsp;which has since resolved, and her current presentation favors another diagnosis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Aspirin\"><\/span>D. Aspirin<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Antiplatelet_medications\" target=\"_blank\" rel=\"noreferrer noopener\">Aspirin&nbsp;<\/a>should be given to patients with suspected&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Myocardial_infarction\" target=\"_blank\" rel=\"noreferrer noopener\">myocardial infarction<\/a>. However, this patient\u2019s presentation is more consistent with a thyroid storm. Although antipyretic medications can bring down the patient&#8217;s fever, aspirin can increase serum free T4 and T3 concentrations by interfering with their protein binding, and therefore,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Acetaminophen_(Paracetamol)\" target=\"_blank\" rel=\"noreferrer noopener\">acetaminophen&nbsp;<\/a>should be used instead for fever reduction.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Dantrolene\"><\/span>E. Dantrolene<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Skeletal_muscle_relaxants:_Nursing_Pharmacology\" target=\"_blank\" rel=\"noreferrer noopener\">Dantrolene&nbsp;<\/a>is a ryanodine receptor antagonist used in patients with malignant hyperthermia, a life-threatening condition caused after administration of inhaled anesthetics or succinylcholine. The condition causes hyperthermia and severe muscle contractions. This patient did not receive any of the aforementioned medications.medications.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T114351.969.png\" alt=\"Ace your clerkships with clinical practice videos on Osmosis Watch now.\" class=\"wp-image-2058\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T114351.969.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T114351.969.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient is presenting with&nbsp;<strong>acute onset<\/strong>&nbsp;of nausea, vomiting, diarrhea, arrhythmia, and very&nbsp;<strong>high fever<\/strong>. In the light of the known noncompliance with medications and long-standing&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Graves_disease\" target=\"_blank\" rel=\"noreferrer noopener\">Graves disease<\/a>, the most likely diagnosis is a&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Thyroid_storm\" target=\"_blank\" rel=\"noreferrer noopener\">thyroid storm<\/a><\/strong>.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Thyroid storm - causes, symptoms, diagnosis, treatment, pathology\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/-naOgnjJlz0?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Thyroid storm is a rare,&nbsp;<strong>life<\/strong>&#8211;<strong>threatening condition<\/strong>&nbsp;typified by severe clinical manifestations of thyrotoxicosis. The condition is caused by longstanding untreated\/undertreated&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hyperthyroidism:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">hyperthyroidism<\/a>&nbsp;(e.g., Graves disease,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Toxic_multinodular_goiter\" target=\"_blank\" rel=\"noreferrer noopener\">toxic multinodular goiter<\/a>, toxic adenoma). It may be&nbsp;<strong>precipitated by an acute stress<\/strong>&nbsp;event such as surgery, trauma, infection, iodine overload, or labor. Patients may present with agitation, anxiety,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Dementia_and_delirium:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">delirium<\/a>, psychosis, stupor, coma, tachycardia, and congestive heart failure. Hypotension, cardiac arrhythmia, and death from cardiovascular collapse may also occur.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Laboratory findings include overt primary hyperthyroidism:&nbsp;<strong>low TSH<\/strong>&nbsp;and high&nbsp;<strong>free&nbsp;<\/strong>T4 and\/or T3 concentrations. Testing may also reveal mild hyperglycemia, mild&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hypercalcemia\" target=\"_blank\" rel=\"noreferrer noopener\">hypercalcemia<\/a>, abnormal liver function tests, leukocytosis, or leukopenia. Treatment includes beta-blockers, antithyroid drugs, iodine solution, and&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Glucocorticoids\" target=\"_blank\" rel=\"noreferrer noopener\">glucocorticoids<\/a>, as described in the table below.below.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"828\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T114455.681.png?w=1024\" alt=\"Osmosis table of pathogenesis, clinical presentation, laboratory findings and treatment of thyroid storm.\" class=\"wp-image-2059\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T114455.681.png 1386w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T114455.681.png?resize=300,243 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T114455.681.png?resize=768,621 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T114455.681.png?resize=1024,828 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><a href=\"https:\/\/www.osmosis.org\/learn\/Thyroid_storm\" target=\"_blank\" rel=\"noreferrer noopener\">Thyroid storm<\/a><\/strong>&nbsp;is a&nbsp;<strong>life<\/strong>&#8211;<strong>threatening condition<\/strong>&nbsp;characterized by overt thyrotoxicosis in the setting of longstanding untreated\/undertreated hyperthyroidism. It can be<strong>&nbsp;precipitated by an acute stress<\/strong>&nbsp;event such as trauma or infection. Patients usually present with altered mental status and cardiovascular instability. Treatment includes beta-blockers, antithyroid drugs, iodine solution, and glucocorticoids.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span><strong>References<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Nayak B, Burman K.&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17127140\/\" target=\"_blank\" rel=\"noreferrer noopener\">Thyrotoxicosis and thyroid storm<\/a>. Endocrinol Metab Clin North Am 2006; 35:663.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Chiha M, Samarasinghe S, Kabaker AS.&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/23920160\/\" target=\"_blank\" rel=\"noreferrer noopener\">Thyroid storm: an updated review<\/a>. J Intensive Care Med 2015; 30:131.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ross DS, Burch HB, Cooper DS, et al.&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27521067\/\" target=\"_blank\" rel=\"noreferrer noopener\">2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis<\/a>. Thyroid 2016; 26:1343.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><br><strong>Want more &nbsp;USMLE\u00ae Step 2 CK practice questions?&nbsp;Try Osmosis today!&nbsp;<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">Access your free trial<\/a>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/register\"><img loading=\"lazy\" decoding=\"async\" width=\"498\" height=\"178\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_bfd4bc.png\" alt=\"Learn more and forget less create an osmosis account.\" class=\"wp-image-2060\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_bfd4bc.png 498w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_bfd4bc.png?resize=300,107 300w\" sizes=\"auto, (max-width: 498px) 100vw, 498px\" \/><\/a><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>Here&#8217;s another USMLE\u00ae Step 2 CK Question of the Day!&nbsp;Today&#8217;s case involves a 45-year-old woman with altered mental status, nausea, vomiting, and diarrhea. Medical history is remarkable for long-standing&nbsp;Graves disease&nbsp;and&nbsp;gastroesophageal reflux disease. IV propranolol is initiated. Which additional medications should also be administered to this patient? A 45-year-old woman presents to the emergency department due [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":2056,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,45],"tags":[],"class_list":["post-2055","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 CK Question of the Day: Thyroid Storm - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-thyroid-storm\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 CK Question of the Day: Thyroid Storm - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Here&#8217;s another USMLE\u00ae Step 2 CK Question of the Day!&nbsp;Today&#8217;s case involves a 45-year-old woman with altered mental status, nausea, vomiting, and diarrhea. Medical history is remarkable for long-standing&nbsp;Graves disease&nbsp;and&nbsp;gastroesophageal reflux disease. IV propranolol is initiated. Which additional medications should also be administered to this patient? A 45-year-old woman presents to the emergency department due [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-thyroid-storm\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2022-01-01T17:42:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-01T19:40:32+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/92.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1081\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Marina Horiates Kerekes, MD &amp; Team\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-thyroid-storm#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-thyroid-storm\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; 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Today's case involves a 56-year-old woman with asthma and notable skin tightening over the face, hands, and forearms.\u00a0Can you figure it out? 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Do you know which test(s) should be given? A 67-year-old man presents to the clinic for evaluation of difficulty swallowing that began with solids and\u2026","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE\u00ae Step 2 Question of the Day: Difficulty swallowing","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-12T214236.367.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-12T214236.367.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-12T214236.367.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-12T214236.367.webp 2x"},"classes":[]},{"id":7913,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-jaundiced-skin","url_meta":{"origin":2055,"position":2},"title":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Jaundiced skin","author":"Rowan Bell, MD &amp; Marina Horiates Kerekes, MD","date":"October 20, 2025","format":false,"excerpt":"Evaluate a patient presenting with jaundice and altered mental status using targeted physical exam findings to guide further diagnostic steps.","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"Step 2 Question of the Day Jaundiced Skin","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Jaundiced-Skin.jpg","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Jaundiced-Skin.jpg 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Jaundiced-Skin.jpg 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Jaundiced-Skin.jpg 2x"},"classes":[]},{"id":5886,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-hematochezia","url_meta":{"origin":2055,"position":3},"title":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Hematochezia","author":"Marina Horiates Kerekes, MD &amp; Team","date":"April 30, 2025","format":false,"excerpt":"Prep for the USMLE\u00ae Step 2 CK exam with this clinical case involving a 46-year-old woman presenting with hematochezia and abdominal discomfort. Learn to identify the most significant risk factor related to her condition, focusing on the importance of family history in diagnosing potential hereditary cancer syndromes. Strengthen your clinical\u2026","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"Step 2 CK Question of the Day Hematochezia","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/Step-2_Question-of-the-day-Hematochezia.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/Step-2_Question-of-the-day-Hematochezia.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/Step-2_Question-of-the-day-Hematochezia.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/Step-2_Question-of-the-day-Hematochezia.png 2x"},"classes":[]},{"id":1897,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-thyroid-management","url_meta":{"origin":2055,"position":4},"title":"USMLE\u00ae Step 2 Question of the Day: Thyroid management","author":"Marina Horiates Kerekes, MD &amp; Team","date":"February 28, 2024","format":false,"excerpt":"Assess clinical features and management strategies in a thyroid case presenting with hyperthyroidism and eye symptoms, highlighting key considerations in treatment choices. What's the answer? Let's find out!","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE Step 2 Question of the Day Thyroid management","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/70.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/70.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/70.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/70.webp 2x"},"classes":[]},{"id":3062,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-oral-loratadine","url_meta":{"origin":2055,"position":5},"title":"USMLE\u00ae Step 1 Question of the Day: Oral loratadine","author":"Marina Horiates Kerekes, MD &amp; Team","date":"November 1, 2023","format":false,"excerpt":"This week, we are sharing another USMLE\u00ae\u00a0Step 1-style\u00a0practice question to test your knowledge of medical topics.\u00a0Today's case focuses on a 20-year-old woman with a history of well-controlled asthma presents with springtime allergies while training for a marathon. 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