What triggers you to choose urgent thyroidectomy versus therapeutic plasma exchange versus continued medical management for refractory thyroid storm despite 12-24 hours of guideline-concordant therapy?

What triggers you to choose urgent thyroidectomy versus therapeutic plasma exchange versus continued medical management for refractory thyroid storm despite 12-24 hours of guideline-concordant therapy?

• I would continue medical management for 24-48 hours before considering plasmapheresis unless the patient is clinically unstable
• For most patients, the combined use of anti-thyroid drugs, stress dose steroids, beta blocker drip and iodine is sufficient for treatment of thyroid storm
• I have never considered urgent thyroidectomy in patients with ongoing elevated thyroid hormone levels due to the associated surgical complications
• I do not have any experience treating thyroid storm
• Other