From the Guidelines
The treatment for hyperthyroidism typically involves medications, radioactive iodine therapy, or surgery, depending on the cause, severity, and patient factors. Anti-thyroid medications like methimazole (10-30 mg daily) or propylthiouracil (100-300 mg daily in divided doses) are often first-line treatments, working by blocking thyroid hormone production 1. These medications are usually taken for 12-18 months, with regular monitoring of thyroid function every 4-6 weeks initially. Beta-blockers such as propranolol (10-40 mg, 3-4 times daily) may be added to control symptoms like rapid heart rate and tremors. For definitive treatment, radioactive iodine (I-131) is commonly used, administered as a single oral dose that selectively destroys overactive thyroid tissue. Thyroidectomy (surgical removal of part or all of the thyroid) is another option, particularly for patients with large goiters, pregnant women who cannot tolerate anti-thyroid drugs, or those with suspected thyroid cancer. Following radioactive iodine or surgery, many patients develop hypothyroidism and require lifelong thyroid hormone replacement with levothyroxine. Treatment choice depends on the patient's age, pregnancy status, severity of hyperthyroidism, and underlying cause, with the goal of normalizing thyroid function while minimizing side effects.
Some key points to consider in the treatment of hyperthyroidism include:
- The use of antithyroid medications, such as methimazole, as a first-line treatment for hyperthyroidism 1
- The role of radioactive iodine therapy in the definitive treatment of hyperthyroidism, particularly for patients with overt Graves disease or nodular thyroid disease 1
- The importance of regular monitoring of thyroid function and adjustment of treatment as needed to minimize side effects and prevent complications 1
- The need for lifelong thyroid hormone replacement with levothyroxine for patients who develop hypothyroidism after radioactive iodine or surgery 1
- The consideration of patient factors, such as age, pregnancy status, and underlying cause, in the selection of treatment for hyperthyroidism 1
- The lack of direct evidence that treatment of thyroid dysfunction based on risk level alters final health outcomes, highlighting the need for further research in this area 1
From the FDA Drug Label
Methimazole tablets, USP are indicated: In patients with Graves’ disease with hyperthyroidism or toxic multinodular goiter for whom surgery or radioactive iodine therapy is not an appropriate treatment option. Methimazole inhibits the synthesis of thyroid hormones and thus is effective in the treatment of hyperthyroidism.
The treatment for hyperthyroidism includes:
- Methimazole (PO): to inhibit the synthesis of thyroid hormones 2 2
- Surgery: for patients with Graves’ disease with hyperthyroidism or toxic multinodular goiter for whom methimazole is not an appropriate treatment option 2
- Radioactive iodine therapy: for patients with Graves’ disease with hyperthyroidism or toxic multinodular goiter for whom methimazole is not an appropriate treatment option 2
- Thyroidectomy: methimazole can be used to ameliorate symptoms of hyperthyroidism in preparation for thyroidectomy 2
From the Research
Treatment Options for Hyperthyroidism
- The treatment options for overt hyperthyroidism from autonomous thyroid nodules or Graves disease include antithyroid drugs, radioactive iodine ablation, and surgery 3, 4.
- Treatment for subclinical hyperthyroidism is recommended for patients at highest risk of osteoporosis and cardiovascular disease, such as those older than 65 years or with persistent serum thyrotropin level less than 0.1 mIU/L 3.
- First-line treatments are antithyroid drugs, thyroid surgery, and radioactive iodine treatment 3.
Antithyroid Drugs
- Methimazole is an antithyroid drug that can be used to treat hyperthyroidism 5, 6.
- Pretreating patients with methimazole before radioactive iodine therapy does not interfere with the final outcome 5.
- Long-term methimazole therapy is superior to radioactive iodine treatment in patients with toxic multinodular goiter, as shown by the earlier achievement of euthyroidism and the longer duration of sustained normal serum thyrotropin 6.
Radioactive Iodine Ablation
- Radioactive iodine ablation is the most widely used treatment in the United States for hyperthyroidism caused by overproduction of thyroid hormones 4.
- Radioactive iodine administration must always be preceded by pharmacological normalization of thyroid function 7.
- Indications for radioiodine therapy in Graves-Basedow disease include recurrent hyperthyroidism after thyrostatic treatment or thyroidectomy and side-effects observed during thyrostatic treatment 7.
- Absolute contraindications for radioiodine treatment are pregnancy and lactation, while relative contraindications are thyroid nodules suspected of malignancy and age under 15 years 7.