From the Guidelines
Hyperthyroidism is best treated with antithyroid medications, such as methimazole or propylthiouracil, which block thyroid hormone production and are typically used for 12-18 months, as recommended by the most recent and highest quality study 1. The treatment of hyperthyroidism depends on the cause and severity of the condition.
- The main treatment options include:
- Antithyroid medications, such as methimazole (10-30 mg daily) or propylthiouracil (100-300 mg daily divided into multiple doses)
- Radioactive iodine therapy
- Surgery
- Beta-blockers, such as propranolol (20-40 mg 3-4 times daily) or atenolol (25-50 mg daily), can help control symptoms like rapid heart rate and tremors while waiting for definitive treatment to take effect.
- Treatment choice depends on factors including the patient's age, pregnancy status, severity of hyperthyroidism, and underlying cause.
- Regular monitoring of thyroid function tests is essential during treatment, with adjustments made based on clinical response.
- Patients should be informed about potential side effects, including rare but serious reactions like agranulocytosis with antithyroid medications, which requires immediate medical attention if fever or sore throat develops, as noted in earlier studies 1. However, the most recent study 1 provides the most up-to-date guidance on the treatment of hyperthyroidism, emphasizing the importance of individualized treatment approaches.
From the FDA Drug Label
Propylthiouracil is indicated: in patients with Graves’ disease with hyperthyroidism or toxic multinodular goiter who are intolerant of methimazole and for whom surgery or radioactive iodine therapy is not an appropriate treatment option. Propylthiouracil is used to decrease symptoms of hyperthyroidism in preparation for a thyroidectomy (removal of the thyroid gland) or radioactive iodine therapy.
Treatment of Hyperthyroidism: Propylthiouracil is used to treat hyperthyroidism in patients with Graves’ disease or toxic multinodular goiter who are intolerant of methimazole. It can be used to decrease symptoms of hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy.
- Key Points:
- Used in patients intolerant of methimazole
- Used to prepare patients for thyroidectomy or radioactive iodine therapy
- Indicated for Graves’ disease with hyperthyroidism or toxic multinodular goiter 2
From the Research
Treatment Options for Hyperthyroidism
- Antithyroid medications, such as methimazole (MMI) and propylthiouracil (PTU), are used to treat hyperthyroidism by inhibiting the synthesis of thyroid hormone 3, 4, 5
- Radioactive iodine ablation of the thyroid gland is a common treatment for hyperthyroidism, especially in the United States 4, 6
- Surgical thyroidectomy is also an option for treating hyperthyroidism, especially in cases where other treatments are not effective or suitable 4, 6
- Long-term treatment with antithyroid drugs can be effective and safe, and may even be superior to radioiodine therapy in some aspects 7
Choice of Treatment
- The choice of treatment depends on the underlying diagnosis, the presence of contraindications to a particular treatment modality, the severity of hyperthyroidism, and the patient's preference 4, 6
- MMI is often the drug of choice due to its widespread availability, longer half-life, and small number of severe side effects 3
- PTU is not recommended for initial use, especially in severe cases of hyperthyroidism 5
Efficacy and Safety of Treatment
- MMI 30 mg/d has been shown to be more effective than PTU 300 mg/d and MMI 15 mg/d in normalizing serum free T4 (FT4) levels in patients with hyperthyroidism caused by Graves' disease 5
- Long-term treatment with antithyroid drugs can induce control of hyperthyroidism without rendering the patient hypothyroid in the majority of patients 7
- Adverse effects, such as mild hepatotoxicity, are higher with PTU and significantly lower with MMI 15 mg/d compared to MMI 30 mg/d 5