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Hyperthyroidism, the increased activity of the thyroid gland, is associated with the risk of developing a thyroid storm, a potentially fatal complication. A thyroid storm is a toxic condition of hyperactivity characterized by fever, sweating, rapid heartbeat, accumulation of fluid in the lungs, tremulousness, and restlessness. This disorder occurs in patients with poorly controlled hyperthyroidism and may be triggered by infection, injury, or emergency surgery. A thyroid storm is treated by catecholamine inhibitors, drugs that prevent the actions of catecholamine hormones, which are involved in activating various cell processes. A case is described of a 20-year-old woman who suffered a thyroid storm due to appendicitis and was unresponsive to propranolol, which is commonly used to treat thyroid crises. However, the thyroid storm was successfully treated with the beta blocker esmolol, which has a very short duration of action. Beta blocking agents prevent the activation of beta receptors, which are membrane proteins that bind catecholamine hormones, and thereby activate various cell responses such as heart rate and contraction. In this case, beta blockade resulted in a decrease in heart rate from 132 to 150 beats per minute to 100 beats per minute after treatment with esmolol. Because esmolol has a very short duration of action, lasting 10 to 20 minutes, the dose can be closely monitored and controlled to achieve the desired effect. Ultrashort-acting agents such as esmolol are useful when prevention of effects of excess thyroid hormone is rapidly needed. This case shows that esmolol is effective in treating thyrotoxic patients who require emergency surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)