What are the treatment options for hyperthyroidism (excessive thyroid hormone production)?

From the Guidelines

Hyperthyroidism is treated with antithyroid medications, such as methimazole, or nonreversible thyroid ablation therapy, including radioactive iodine or surgery, particularly for patients with a TSH level that is undetectable or less than 0.1 mIU/L, as recommended by the US Preventive Services Task Force 1. The treatment approach depends on the cause and severity of the condition, as well as individual patient factors such as age, pregnancy status, and underlying health conditions.

• Antithyroid medications, like methimazole, are often used as the first-line treatment to block thyroid hormone production.
• Beta-blockers, such as propranolol, can be added to control symptoms like rapid heart rate and tremors.
• Radioactive iodine therapy is a common definitive treatment option, which selectively destroys overactive thyroid tissue.
• Surgical removal of part or all of the thyroid (thyroidectomy) is considered for patients with large goiters, pregnant women who cannot tolerate antithyroid drugs, or those with suspected thyroid cancer.
• After definitive treatment, many patients develop hypothyroidism and require lifelong thyroid hormone replacement with levothyroxine, highlighting the importance of regular monitoring of thyroid function during and after treatment 1. Key factors influencing the choice of treatment include the patient's age, pregnancy status, severity of hyperthyroidism, and the underlying cause of the condition. It is essential to prioritize the patient's morbidity, mortality, and quality of life when selecting a treatment approach, considering the potential benefits and risks of each option. In clinical practice, the most recent and highest quality study, such as the 2022 study on individualized beta-blocker treatment for high blood pressure 1, should guide treatment decisions to ensure optimal outcomes for patients with hyperthyroidism.

From the FDA Drug Label

Thyroid function tests should be monitored periodically during therapy Once clinical evidence of hyperthyroidism has resolved, the finding of an elevated serum TSH indicates that a lower maintenance dose of propylthiouracil should be employed.

The treatment option for hyperthyroidism mentioned in the drug label is propylthiouracil (PO), an antithyroid drug.

• The goal of treatment is to resolve clinical evidence of hyperthyroidism and then adjust the dose based on thyroid function tests, such as serum TSH levels 2.
• Monitoring of thyroid function tests is necessary during therapy to determine the appropriate dose.
• Dose adjustment may be needed to maintain a lower maintenance dose once hyperthyroidism has resolved.

From the Research

Treatment Options for Hyperthyroidism

The treatment options for hyperthyroidism include:

• Antithyroid drugs, such as methimazole and propylthiouracil, which can be used to manage the condition, especially in the initial stages or in preparation for more definitive treatments 3, 4, 5, 6, 7
• Radioactive iodine ablation, which is a widely used treatment in the United States, especially for patients with Graves' disease, toxic multinodular goiter, and toxic adenoma 4, 6, 7
• Surgical thyroidectomy, which can be considered for patients who have contraindications to radioactive iodine, have a large goiter, or have compressive symptoms, and is often recommended for patients with Graves' disease and ophthalmic manifestations 3, 4, 6, 7

Considerations for Treatment

When deciding on a treatment option, several factors should be considered, including:

• The underlying cause of hyperthyroidism, such as Graves' disease, toxic multinodular goiter, or toxic adenoma 3, 4, 6
• The presence of contraindications to a particular treatment modality, such as pregnancy or breastfeeding 3, 4
• The severity of hyperthyroidism and the presence of symptoms, such as nervousness, heat intolerance, weight loss, and fatigue 5
• The patient's preference and the potential risks and benefits of each treatment option 4, 6

Special Considerations

Special consideration should be given to patients who are pregnant or breastfeeding, as well as those with Graves' ophthalmopathy or amiodarone-induced hyperthyroidism 4, 7 Patients with subclinical hyperthyroidism may not require treatment, but close monitoring is necessary to prevent disease complications or progression to overt hyperthyroidism 5 Thyroid storm is a life-threatening complication of unmanaged or inadequately managed hyperthyroidism that requires urgent treatment in a hospital setting 5, 7