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Hyperthyroidism Management
Aka: Hyperthyroidism Management, Grave Disease Management
- See Also
- Thyroid Storm
- Hyperthyroidism
- Grave's Disease
- Subclinical Hyperthyroidism
- Hyperthyroidism in Pregnancy
- Precautions
- Thyroiditis is managed symptomatically (see antiandrenergic medications below)
- Anticipate resolution spontaneously by 6 months
- Drug-Induced Thyroiditis should also prompt removal of offending agent
- Antithyroid medications and Thyroid ablation are NOT indicated in Thyroiditis
- Antithyroid medications and Thyroid ablation are primarily for Grave Disease and toxic Goiters
- Medications: Antiadrenergic Medications
- Indications
- Thyroiditis
- Concurrent initially with ablation, PTU/MTZ, surgery
- Symptomatic control
- Controls Tremor, Palpitations, nervousness
- Beta Blockers (non-selective preferred)
- Propranolol
- Also blocks peripheral T4 to T3 conversion (by inhibiting 5'-monodeiodinase)
- Start: 10-20 mg PO q6 hours
- Advance to 20 to 80 mg PO q6 hours
- Diltiazem (Cardizem)
- Alternative if Beta Blockers not tolerated
- Medications: Antithyroid Medications
- Indications
- Hyperthyroidism in children and adolescents
- Pregnancy
- Propylthiouracil in first trimester, Methimazole in second trimester
- Severe Grave's Disease
- Antithyroid Medications (Thionamides)
- Methimazole 15-30 mg per day (up to 120 mg)
- Propylthiouracil (PTU) 100-200 mg orally every 8 hours
- Indicated in pregnancy first trimester
- Monitoring
- See Antithyroid Medications
- Management: Ablation
- Radioactive Iodine (I-131)
- Management of choice for Grave's Disease of all ages (not in pregnancy or moderate Graves Orbitopathy)
- Recurrent Hyperthyroidism after Antithyroid Drugs
- Toxic Multinodular Goiter
- Toxic Nodule in patient over age 40 years old
- Subtotal Thyroidectomy
- Pregnancy
- Children intollerant to antithyroid medications
- Toxic Nodule under age 40 years old
- Large Thyroid Goiter causing local compression
- Monitoring after ablation
- Thyroid Stimulating Hormone (TSH) may not be initially accurate
- Follow Free T4, Free T3 to base Thyroid Replacement
- References
- Ginsberg (2003) CMAJ 168:575-85 [PubMed]
- Kravets (2016) Am Fam Physician 93(5): 363-70 [PubMed]
- Reid (2005) Am Fam Physician 72:623-36 [PubMed]