From the FDA Drug Label
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 for hyperthyroidism with symptoms of low Thyroid-Stimulating Hormone (TSH) involves the use of propylthiouracil.
- Key points:
- The dose of propylthiouracil should be adjusted based on the patient's serum TSH levels.
- An elevated serum TSH indicates that a lower maintenance dose of propylthiouracil should be employed.
- Patients should be under close surveillance and counseled regarding the necessity of immediately reporting any evidence of illness.
- Propylthiouracil can cause serious side effects, including severe liver problems, low white blood cell counts, and vasculitis.
- Patients should report any symptoms of hepatic dysfunction, illness, or infection to their doctor immediately. 1
From the Research
Treatment for hyperthyroidism with low TSH typically involves medications, radioactive iodine therapy, or surgery, with anti-thyroid medications like methimazole being the preferred first-line treatment, as stated in the most recent study 2. The most common causes of hyperthyroidism are Graves' disease and toxic nodular goitre, and the treatment approach may vary depending on the underlying cause.
- Anti-thyroid medications, such as methimazole, are often used as first-line treatments, working by blocking thyroid hormone production.
- Beta-blockers, such as propranolol, may be added to control symptoms like rapid heart rate and tremors.
- Radioactive iodine (I-131) can be administered as a one-time oral dose to destroy overactive thyroid tissue.
- Thyroidectomy (surgical removal of part or all of the thyroid) is another option, particularly for pregnant women who cannot take anti-thyroid drugs or patients with very large goiters. According to the study 2, long-term treatment with antithyroid drugs (ie, 5-10 years of treatment) is feasible and associated with fewer recurrences (15%) than short-term treatment (ie, 12-18 months of treatment). Regular monitoring of thyroid function is essential during treatment, as some patients may eventually develop hypothyroidism requiring thyroid hormone replacement, as mentioned in the study 3. It is also important to note that hyperthyroidism is associated with increased mortality, and prognosis might be improved by rapid and sustained control of hyperthyroidism, as stated in the study 2. Innovative new treatments are expected for Graves' disease, by targeting B cells or TSH receptors, which may provide alternative treatment options in the future. Overall, the treatment approach for hyperthyroidism with low TSH should be individualized and based on the most recent and highest quality evidence, such as the study 2.