In managing thyroid storm, which medication class is used to rapidly control adrenergic symptoms?

• A. Beta-blocker
• B. Calcium channel blocker
• C. ACE inhibitor
• D. Vasopressor

Answer: (A)

Thyroid storm drives a surge of adrenergic activity, so rapidly tamping down those symptoms requires blocking beta-adrenergic receptors. Beta-blockers do this effectively by preventing catecholamines from stimulating the heart and other tissues, which quickly lowers heart rate, blood pressure, tremor, and anxiety. Propranolol is especially useful because it is nonselective and also reduces conversion of the less active T4 to the more active T3, helping to blunt the thyroid hormone effect as well. Other drug classes don’t address this adrenergic overdrive: calcium channel blockers don’t directly block catecholamine signaling, while ACE inhibitors or vasopressors can fail to alleviate or even worsen the adrenergic symptoms. In urgent situations, fast-acting IV beta-blockers like esmolol can be used to titrate control precisely.