Hyperthyroidism Management

Aka: Hyperthyroidism Management, Grave Disease Management

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II. Precautions

  1. Thyroiditis is managed symptomatically (see antiandrenergic medications below)
    1. Anticipate resolution spontaneously by 6 months
    2. Drug-Induced Thyroiditis should also prompt removal of offending agent
    3. Antithyroid medications and Thyroid ablation are NOT indicated in Thyroiditis
  2. Antithyroid medications and Thyroid ablation are primarily for Grave Disease and toxic Goiters

III. Medications: Antiadrenergic Medications

  1. Indications
    1. Thyroiditis
    2. Concurrent initially with ablation, PTU/MTZ, surgery
    3. Symptomatic control
      1. Controls Tremor, Palpitations, nervousness
  2. Beta Blockers (non-selective preferred)
    1. Propranolol
      1. Also blocks peripheral T4 to T3 conversion (by inhibiting 5'-monodeiodinase)
      2. Start: 10-20 mg PO q6 hours
      3. Advance to 20 to 80 mg PO q6 hours
  3. Diltiazem (Cardizem)
    1. Alternative if Beta Blockers not tolerated

IV. Medications: Antithyroid Medications

  1. Indications
    1. Hyperthyroidism in children and adolescents
    2. Pregnancy
      1. Propylthiouracil in first trimester, Methimazole in second trimester
    3. Severe Grave's Disease
  2. Antithyroid Medications (Thionamides)
    1. Methimazole 15-30 mg per day (up to 120 mg)
    2. Propylthiouracil (PTU) 100-200 mg orally every 8 hours
      1. Indicated in pregnancy first trimester
  3. Monitoring
    1. See Antithyroid Medications

V. Management: Ablation

  1. Radioactive Iodine (I-131)
    1. Management of choice for Grave's Disease of all ages (not in pregnancy or moderate Graves Orbitopathy)
    2. Recurrent Hyperthyroidism after Antithyroid Drugs
    3. Toxic Multinodular Goiter
    4. Toxic Nodule in patient over age 40 years old
  2. Subtotal Thyroidectomy
    1. Pregnancy
    2. Children intollerant to antithyroid medications
    3. Toxic Nodule under age 40 years old
    4. Large Thyroid Goiter causing local compression
  3. Monitoring after ablation
    1. Thyroid Stimulating Hormone (TSH) may not be initially accurate
    2. Follow Free T4, Free T3 to base Thyroid Replacement

VI. References

  1. Ginsberg (2003) CMAJ 168:575-85 [PubMed]
  2. Kravets (2016) Am Fam Physician 93(5): 363-70 [PubMed]
  3. Reid (2005) Am Fam Physician 72:623-36 [PubMed]

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Related Studies

Ontology: Hyperthyroidism (C0020550)

Definition (NCI_CTCAE) A disorder characterized by excessive levels of thyroid hormone in the body. Common causes include an overactive thyroid gland or thyroid hormone overdose.
Definition (NCI) Overactivity of the thyroid gland resulting in overproduction of thyroid hormone and increased metabolic rate. Causes include diffuse hyperplasia of the thyroid gland (Graves' disease), single nodule in the thyroid gland, and thyroiditis. The symptoms are related to the increased metabolic rate and include weight loss, fatigue, heat intolerance, excessive sweating, diarrhea, tachycardia, insomnia, muscle weakness, and tremor.
Definition (NCI_NCI-GLOSS) Too much thyroid hormone. Symptoms include weight loss, chest pain, cramps, diarrhea, and nervousness.
Definition (CSP) excessive functional activity of the thyroid gland.
Definition (MSH) Hypersecretion of THYROID HORMONES from the THYROID GLAND. Elevated levels of thyroid hormones increase BASAL METABOLIC RATE.
Concepts Disease or Syndrome (T047)
MSH D006980
ICD10 E05.9
SnomedCT 190239004, 154655004, 267464006, 34486009
LNC MTHU020782
English Hyperthyroidism, HYPERTHYROIDISM, hyperthyroidism, hyperthyroidism (diagnosis), Hyperthyroidism NOS, Hyperthyroidism [Disease/Finding], hyperthyroidism nos, hyperthyroid, Primary Hyperthyroidism, Hyperthyroid, overactive thyroid, Hyperthyroidism (disorder), Hyperthyroidism, NOS, Overactive Thyroid
French HYPERTHYROIDIE, Hyperthyréose, Hyperthyroïdie, Hyperthyroïdisme
Spanish HIPERTIROIDISMO, hipertiroidismo (trastorno), hipertiroidismo, Hipertiroidismo
German HYPERTHYREOSE, Hyperthyroidismus, Hyperthyreoidismus, Hyperthyreose
Japanese 甲状腺機能亢進症, ｺｳｼﾞｮｳｾﾝｷﾉｳｺｳｼﾝｼｮｳ
Swedish Hypertyreos
Finnish Kilpirauhasen liikatoiminta
Russian GIPERTIREOIDIZM, GIPERTIREOZ, ГИПЕРТИРЕОЗ, ГИПЕРТИРЕОИДИЗМ
Portuguese HIPERTIROIDISMO, Hipertiroidismo, Hipertireoidismo
Czech Hypertyreóza, primární hypertyreóza, hyperthyreoidismus, hypertyreóza, hypertyreoidismus, hyperthyreóza
Croatian HIPERTIREOZA
Polish Nadczynność tarczycy
Hungarian Hyperthyreosis
Norwegian Hypertyreose, Høyt stoffskifte
Dutch hyperthyroïdie, Basedow, ziekte van, Hyperthyreose, Hyperthyreoïdie, Hyperthyroïdie, Thyreoïdie, hyper-
Italian Ipertiroidismo
Derived from the NIH UMLS (Unified Medical Language System)

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