American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the role of high-dose glucocorticoids in managing thyroid storm?

To treat infection
To block peripheral conversion of T4 to T3
To reduce blood pressure
To increase metabolism

The correct answer is: To block peripheral conversion of T4 to T3

In managing thyroid storm, high-dose glucocorticoids play a crucial role by effectively blocking the peripheral conversion of T4 (thyroxine) to T3 (triiodothyronine). This is particularly important in thyroid storm, a life-threatening condition that results from excessive thyroid hormone levels. In this situation, high levels of circulating T3 are responsible for many of the hypermetabolic symptoms observed, including heightened heart rate, elevated body temperature, and increased metabolic demands. By administering glucocorticoids, clinicians can help mitigate the effects of excessive thyroid hormones by inhibiting the conversion process. This disruption reduces the overall activity of T3, leading to a decrease in the severe hypermetabolism characteristic of thyroid storm. Additionally, glucocorticoids have the added benefit of addressing adrenal insufficiency that might be present in patients experiencing extreme stress or illness, thereby stabilizing the patient's condition. Understanding this mechanism highlights the importance of glucocorticoids in the acute management of thyroid storm beyond their anti-inflammatory properties.