From the Guidelines
Hyperthyroidism should be treated with antithyroid medications, such as methimazole or propylthiouracil, to reduce thyroid hormone production and alleviate symptoms, with the goal of improving quality of life and reducing morbidity and mortality. The treatment approach typically involves a combination of medications, including antithyroid drugs and beta-blockers, to manage symptoms and control the condition. According to the most recent evidence 1, hyperthyroidism in pregnant women is treated with a thioamide, such as propylthiouracil or methimazole, with the goal of maintaining FT4 or FTI in the high-normal range using the lowest possible thioamide dosage.
Symptoms of Hyperthyroidism
- Weight loss despite increased appetite
- Anxiety
- Heat intolerance
- Tremors
- Irregular heartbeat
- Other symptoms may include increased sweating, fatigue, and changes in menstrual cycle
Treatment Options
- Antithyroid medications, such as methimazole (10-30 mg daily) or propylthiouracil (100-300 mg daily divided into three doses)
- Beta-blockers, such as propranolol (20-40 mg every 6-8 hours), to control symptoms like rapid heart rate and tremors
- Radioactive iodine therapy or thyroid surgery may be necessary for patients with severe or recurrent hyperthyroidism
- Regular monitoring of thyroid function every 4-6 weeks initially, then every 2-3 months once stabilized, is crucial to adjust treatment and prevent complications 1.
Important Considerations
- Patients should avoid iodine-rich foods during treatment
- They should be aware that they may eventually develop hypothyroidism, particularly after radioactive iodine treatment or surgery, requiring lifelong thyroid hormone replacement
- Treatment usually continues for 12-18 months, with regular monitoring of thyroid function to adjust treatment and prevent complications.
From the FDA Drug Label
Propylthiouracil is a prescription medicine used to treat people who have Graves’ disease with hyperthyroidism or toxic multinodular goiter. Propylthiouracil is used when:
- certain other antithyroid medicines do not work well
- thyroid surgery or radioactive iodine therapy is not a treatment option.
- to decrease symptoms of hyperthyroidism in preparation for a thyroidectomy (removal of the thyroid gland) or radioactive iodine therapy.
The symptoms of hyperthyroidism are not directly listed in the provided drug labels, but the treatment options for hyperthyroidism include:
- Propylthiouracil: a prescription medicine used to treat people with Graves’ disease and hyperthyroidism
- Thyroid surgery: an option when other treatments are not suitable
- Radioactive iodine therapy: an option when other treatments are not suitable
- Decreasing symptoms of hyperthyroidism: in preparation for a thyroidectomy or radioactive iodine therapy 2 It is also important to monitor thyroid function tests periodically during therapy with propylthiouracil 2 2
From the Research
Symptoms of Hyperthyroidism
- Nervousness, heat intolerance, weight loss, and fatigue are common symptoms of hyperthyroidism 3
- Anxiety, insomnia, palpitations, unintentional weight loss, diarrhea, and heat intolerance are also symptoms of thyrotoxicosis 4
- Patients with Graves disease may have a diffusely enlarged thyroid gland, stare, or exophthalmos on examination 4
- Patients with toxic nodules may have symptoms from local compression of structures in the neck by the thyroid gland, such as dysphagia, orthopnea, or voice changes 4
Treatment Options for Hyperthyroidism
- Antithyroid medications (methimazole and propylthiouracil) can be used to treat hyperthyroidism caused by overproduction of thyroid hormones 5, 6
- Radioactive iodine ablation of the thyroid gland is a widely used treatment in the United States 5, 7, 4
- Surgical thyroidectomy is also a treatment option for hyperthyroidism 5, 7, 4
- Beta blockers can be used to treat cardiovascular manifestations such as hypertension and tachycardia 7
- Treatment choices should be individualized and patient centered, taking into account the underlying diagnosis, presence of contraindications, severity of hyperthyroidism, and patient preference 5, 4
Management of Subclinical Hyperthyroidism
- Subclinical hyperthyroidism is not always treated, although close monitoring is needed to prevent disease complications or progression to overt hyperthyroidism 3
- Treatment is recommended for patients 65 years or older with TSH levels lower than 0.10 mIU/L, symptomatic patients, or those with cardiac or osteoporotic risk factors 3, 4
- Treatment options for subclinical hyperthyroidism include antithyroid drugs and radioactive iodine ablation 3, 4
Complications of Untreated Hyperthyroidism
- Untreated hyperthyroidism can cause cardiac arrhythmias, heart failure, osteoporosis, and adverse pregnancy outcomes 4
- It may lead to unintentional weight loss and is associated with increased mortality 4
- Thyroid storm is a life-threatening complication of unmanaged or inadequately managed hyperthyroidism that warrants urgent treatment in a hospital setting 7, 3