What is the treatment for hyperthyroidism?

From the Guidelines

The patient with a TSH level of 0.02, FREE T4 of 25.6, and free T3 of 6.7, presenting with itching, should be treated with antithyroid medications, such as methimazole, or nonreversible thyroid ablation therapy, such as radioactive iodine or surgery, as the TSH level is undetectable, indicating overt hyperthyroidism 1. The treatment for hyperthyroidism typically involves:

• Anti-thyroid medications like methimazole (10-30 mg daily) or propylthiouracil (100-300 mg daily in divided doses) to block thyroid hormone production
• Beta-blockers such as propranolol (20-40 mg 3-4 times daily) to control symptoms like rapid heart rate and tremors
• Radioactive iodine (I-131) as a definitive treatment, administered as a single oral dose that selectively destroys overactive thyroid tissue
• Surgical removal of part or all of the thyroid (thyroidectomy) as an option, particularly for large goiters, pregnant women who cannot tolerate anti-thyroid drugs, or when cancer is suspected The choice of treatment depends on the underlying cause of hyperthyroidism, patient age, pregnancy status, and comorbidities, with the goal of normalizing thyroid hormone levels while minimizing side effects 1. Some key points to consider:
• The patient's TSH level is undetectable, indicating overt hyperthyroidism, which requires treatment 1
• The patient's symptoms, such as itching, should be managed with beta-blockers or other medications as needed 1
• The treatment choice should be individualized based on the patient's specific condition and medical history 1

From the FDA Drug Label

Propylthiouracil inhibits the synthesis of thyroid hormones and thus is effective in the treatment of hyperthyroidism. Methimazole inhibits the synthesis of thyroid hormones and thus is effective in the treatment of hyperthyroidism. The patient has hyperthyroidism with a TSH of 0.02, FREE T4 of 25.6, and free T3 of 6.7, and is experiencing itching.

• The treatment for hyperthyroidism includes medications such as Propylthiouracil or Methimazole that inhibit the synthesis of thyroid hormones.
• However, itching is also a symptom of a potential side effect of Propylthiouracil, which is liver problems.
• It is essential to monitor the patient's liver function and adjust the treatment plan accordingly.
• The patient should be advised to report any symptoms of liver problems, such as fever, loss of appetite, nausea, vomiting, tiredness, itchiness, pain or tenderness in the right upper stomach area, dark urine, or pale stools. 2 3 2

From the Research

Treatment for Hyperthyroidism

The patient's symptoms, including itching, and laboratory results (TSH 0.02, FREE T4 25.6, and free T3 6.7) indicate hyperthyroidism. The treatment options for hyperthyroidism include:

• Antithyroid medications, such as methimazole and propylthiouracil, which inhibit the synthesis of thyroid hormones 4, 5
• Radioactive iodine ablation of the thyroid gland, which is the most widely used treatment in the United States 4, 6
• Surgical thyroidectomy, which is considered for patients with contraindications to other treatments or with severe hyperthyroidism 4, 6

Management of Symptoms

In addition to treating the underlying hyperthyroidism, symptoms such as itching can be managed with supportive care. Beta blockers can be used to treat cardiovascular manifestations, such as tachycardia and hypertension 6.

Treatment Choices

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, 7. It is essential to individualize treatment and consider the patient's age, overall health, and other factors 7.

Specific Treatment Options

For a 64-year-old female patient with hyperthyroidism, treatment options may include:

• Antithyroid medications, such as methimazole, which can be used as a first-line treatment 5, 8
• Radioactive iodine ablation, which is a commonly used treatment for hyperthyroidism in the United States 4, 6
• Surgical thyroidectomy, which may be considered if other treatments are not effective or if the patient has a large goiter or other complications 4, 6