From the Guidelines
Treatment options for hyperthyroidism include medications, radioactive iodine therapy, and surgery, with the goal of reducing thyroid hormone production and alleviating symptoms. The choice of treatment depends on the cause of hyperthyroidism, patient age, pregnancy status, and other medical conditions.
- Anti-thyroid medications like methimazole (10-30 mg daily) or propylthiouracil (100-300 mg daily divided into multiple doses) block thyroid hormone production and are typically used for 12-18 months 1.
- Beta-blockers such as propranolol (10-40 mg, 3-4 times daily) help control symptoms like rapid heart rate and tremors but don't affect hormone levels.
- Radioactive iodine (I-131) is taken orally as a one-time treatment that gradually destroys overactive thyroid cells over 6-18 weeks.
- Surgical removal of part or all of the thyroid (thyroidectomy) provides rapid resolution but carries risks of vocal cord damage and hypoparathyroidism. Most patients require regular blood tests to monitor thyroid function during and after treatment, and many eventually need thyroid hormone replacement if their treatment results in hypothyroidism. Patients should maintain adequate iodine intake but avoid excessive iodine consumption during treatment. It is essential to consider the potential risks and benefits of each treatment option, as well as the patient's individual needs and medical history, to determine the most appropriate course of treatment. According to the most recent study 1, thyroid function tests are recommended in all patients presenting with heart failure, as hypothyroidism and hyperthyroidism can coexist with heart failure and impact treatment outcomes.
From the FDA Drug Label
Propylthiouracil is indicated: in patients with Graves’ disease with hyperthyroidism or toxic multinodular goiter who are intolerant of methimazole and for whom surgery or radioactive iodine therapy is not an appropriate treatment option. to ameliorate symptoms of hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy in patients who are intolerant of methimazole.
The treatment options for hyperthyroidism include:
- Medication: Propylthiouracil (PO) can be used to ameliorate symptoms of hyperthyroidism.
- Surgery: Thyroidectomy may be an option for some patients.
- Radioactive iodine therapy: This may be used to treat hyperthyroidism in patients who are intolerant of methimazole and for whom surgery is not an appropriate option 2.
From the Research
Treatment Options for Hyperthyroidism
The treatment options for hyperthyroidism include:
- Antithyroid drugs, such as methimazole (MMI) and propylthiouracil (PTU) 3, 4, 5, 6
- Definitive therapies, such as radioactive iodine ablation and thyroidectomy 7
- Beta blockers to control symptoms such as tremors and palpitations 5
- Iodine, lithium carbonate, and glucocorticoids as second-line treatments 5
- Rituximab, a monoclonal antibody, for cases of Graves' disease unresponsive to traditional drugs 5
Comparison of Methimazole and Propylthiouracil
Studies have compared the efficacy of MMI and PTU in the treatment of hyperthyroidism:
- MMI has been shown to be more effective than PTU in inducing euthyroidism 3, 4, 6
- MMI has a faster onset of action and is more effective in reducing serum T3 and T4 levels 3, 4
- PTU has a higher risk of hepatotoxicity, especially in high doses 6
Recommendations for Treatment
Recommendations for treatment include:
- MMI as the first-line treatment for hyperthyroidism due to its efficacy and safety profile 3, 4, 5, 6
- PTU as an alternative treatment, but with closer monitoring due to the risk of hepatotoxicity 5, 6
- Definitive therapies, such as radioactive iodine ablation and thyroidectomy, for patients who do not respond to antithyroid drugs or have a high risk of complications 7
- Treatment of subclinical hyperthyroidism is recommended for patients 65 years or older with TSH levels lower than 0.10 mIU/L, or for symptomatic patients or those with cardiac or osteoporotic risk factors 7