What is the recommended starting dose of propranolol (beta-blocker) for hyperthyroidism?

From the Guidelines

The recommended starting dose of propranolol for hyperthyroidism is typically 10-40 mg taken orally three to four times daily, with a total daily dose ranging from 30-160 mg. This beta-blocker does not treat the underlying thyroid dysfunction but helps control symptoms like rapid heart rate, palpitations, tremors, anxiety, and heat intolerance while definitive treatment (antithyroid medications, radioactive iodine, or surgery) takes effect. According to the most recent study 1, propranolol is the most widely studied nonselective beta-blocker to treat the increased heart rate and tremor in patients with thyrotoxicosis or symptomatic hyperthyroidism.

Key Considerations

• Dosing should be individualized based on symptom severity and patient response, with careful monitoring of heart rate and blood pressure.
• Propranolol works by blocking beta-adrenergic receptors, reducing the effects of excess thyroid hormone on the cardiovascular system and other tissues.
• Patients should be aware that propranolol may mask certain symptoms of hypoglycemia in diabetic patients and is contraindicated in those with certain cardiac conditions, asthma, or COPD.
• The medication should not be stopped abruptly as this could worsen hyperthyroid symptoms.

Additional Guidance

• The American Association of Clinical Endocrinologists Medical Guidelines for the Evaluation and Treatment of Hyperthyroidism and Hypothyroidism have discussed the use of beta-blockers in conditions characterized by an excess of thyroid hormones without specifically recommending one beta-blocker over another 1.
• Other studies, such as the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1, provide additional guidance on the use of beta-blockers, including propranolol, in various cardiac conditions.

From the Research

Recommended Dose of Propranolol for Hyperthyroidism

The recommended starting dose of propranolol for hyperthyroidism is:

• 40 to 80 mg every 6 or 8 hours orally 2
• 160mg daily 3

Administration and Duration

Propranolol is usually administered until remission of all symptoms of the disease 2. It can be used as a single drug in mild forms of hyperthyroidism, or in combination with antithyroid drugs, iodine, or before radiotherapy or surgery 2.

Important Considerations

Contraindications for the application of beta blockers like propranolol include:

• Asthma
• Chronic obstructive pulmonary disease
• Congestive heart insufficiency 2 Propranolol can improve symptoms such as nervousness, tremor, and tachycardia, but may not have a significant effect on eye signs or basal metabolic rate 3.