What is the treatment for hyperthyroidism?

From the Guidelines

Hyperthyroidism is typically treated with antithyroid medications, such as methimazole, or nonreversible thyroid ablation therapy, including radioactive iodine or surgery, with the goal of normalizing thyroid hormone levels and relieving symptoms while minimizing side effects. The treatment approach depends on the underlying cause of hyperthyroidism, patient age, pregnancy status, and comorbidities. According to the US Preventive Services Task Force recommendation statement 1, hyperthyroidism is treated with antithyroid medications or nonreversible thyroid ablation therapy.

Some key points to consider in the treatment of hyperthyroidism include:

• The use of anti-thyroid medications, such as methimazole, to block thyroid hormone production 1
• The administration of radioactive iodine (I-131) as a single oral dose to destroy overactive thyroid tissue 1
• Surgical removal of part or all of the thyroid (thyroidectomy) for patients with large goiters, pregnant women who cannot tolerate anti-thyroid drugs, or those with suspected thyroid cancer 1
• The importance of regular monitoring of thyroid function and adjusting 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 comorbidities, in determining the most appropriate treatment approach 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 inhibits the synthesis of thyroid hormones and thus is effective in the treatment of hyperthyroidism. Propylthiouracil inhibits the synthesis of thyroid hormones and thus is effective in the treatment of hyperthyroidism. Propylthiouracil is a prescription medicine used to treat people who have Graves’ disease with hyperthyroidism or toxic multinodular goiter.

The treatment for hyperthyroidism includes medications such as:

• Methimazole 2
• Propylthiouracil 3 and 3 These medications inhibit the synthesis of thyroid hormones and are effective in treating hyperthyroidism. Propylthiouracil is used when certain other antithyroid medicines do not work well, thyroid surgery or radioactive iodine therapy is not a treatment option, or to decrease symptoms of hyperthyroidism in preparation for a thyroidectomy or radioactive iodine therapy.

From the Research

Treatment Options for Hyperthyroidism

The treatment for hyperthyroidism depends on the underlying cause of the condition, as well as the severity of the symptoms. The following are some of the common treatment options:

• Antithyroid drugs: These medications, such as methimazole and propylthiouracil, can help reduce the production of thyroid hormones 4, 5.
• Radioactive iodine ablation: This treatment involves taking a radioactive form of iodine to destroy part of the thyroid gland, which can help reduce hormone production 6, 4.
• Thyroidectomy: Surgical removal of the thyroid gland may be necessary in some cases, such as large goiters or cancer 6, 4.
• Beta blockers: These medications can help manage symptoms such as rapid heart rate and tremors, but do not affect thyroid hormone production 7.
• Radiofrequency ablation: This is a minimally invasive procedure that uses heat to destroy thyroid tissue, and is sometimes used to treat toxic nodular goiter 6.

Considerations for Treatment

When choosing a treatment option, the following factors should be considered:

• The underlying cause of the hyperthyroidism: Different causes may require different treatments 6, 8.
• The severity of the symptoms: More severe symptoms may require more aggressive treatment 6, 8.
• The presence of contraindications: Certain medications or treatments may not be suitable for patients with certain medical conditions 7.
• Patient preference: Patients should be involved in the decision-making process and choose a treatment that aligns with their values and preferences 8.

Special Considerations

Certain populations may require special consideration when treating hyperthyroidism, including:

• Pregnant women: Hyperthyroidism can have serious consequences for both the mother and the fetus, and treatment should be carefully managed 6, 8.
• Patients with COVID-19: Hyperthyroidism can increase the risk of complications from COVID-19, and treatment should be adjusted accordingly 6.
• Patients with other complications: Hyperthyroidism can increase the risk of other complications, such as atrial fibrillation and osteoporosis, and treatment should be managed with these conditions in mind 6, 8.