From the Guidelines
Hyperthyroidism should be treated with antithyroid medications, radioactive iodine therapy, or surgery, with the choice of treatment depending on the cause of hyperthyroidism, patient age, pregnancy status, and other medical conditions, as recommended by the most recent guidelines 1. The treatment options for hyperthyroidism include:
- Anti-thyroid medications like methimazole or propylthiouracil, which block thyroid hormone production and are typically used for 12-18 months
- Beta-blockers such as propranolol, which help control symptoms like rapid heart rate and tremors but don't affect hormone production, and are particularly useful in patients with thyrotoxicosis or symptomatic hyperthyroidism 1
- Radioactive iodine (I-131) therapy, which destroys overactive thyroid cells and often leads to hypothyroidism requiring lifelong thyroid hormone replacement
- Thyroidectomy (surgical removal of part or all of the thyroid), which is recommended for patients with large goiters, pregnant women who can't tolerate anti-thyroid drugs, or those with thyroid cancer It is essential to treat hyperthyroidism to prevent serious complications, including heart problems, bone loss, and thyroid storm, a life-threatening condition requiring emergency treatment. Key considerations in choosing a treatment include the patient's overall health, the severity of their hyperthyroidism, and their personal preferences. In general, treatment is recommended for patients with a TSH level that is undetectable or less than 0.1 mIU/L, particularly those with overt Graves disease or nodular thyroid disease 1.
From the FDA Drug Label
Methimazole tablets are indicated: • In patients with Graves’ disease with hyperthyroidism or toxic multinodular goiter 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. Methimazole inhibits the synthesis of thyroid hormones and thus is effective in the treatment of hyperthyroidism.
The treatment options for hyperthyroidism include methimazole tablets, which are indicated for patients with Graves’ disease with hyperthyroidism or toxic multinodular goiter. Methimazole is effective in the treatment of hyperthyroidism by inhibiting the synthesis of thyroid hormones. Other treatment options mentioned include surgery and radioactive iodine therapy, for which methimazole can be used to ameliorate symptoms in preparation. 2 2
From the Research
Treatment Options for Hyperthyroidism
The treatment of hyperthyroidism includes several options, which are chosen based on the underlying diagnosis, the presence of contraindications to a particular treatment modality, the severity of hyperthyroidism, and the patient's preference 3. The main treatment options are:
- Antithyroid drugs (ATDs)
- Radioactive iodine therapy (RAI)
- Surgery
Antithyroid Drugs (ATDs)
ATDs, such as methimazole and propylthiouracil, are used to treat hyperthyroidism by reducing the production of thyroid hormones 3, 4. They are often prescribed for a period of 12 to 18 months to induce a long-term remission in patients with Graves' disease 4.
Radioactive Iodine Therapy (RAI)
RAI is a widely used treatment for hyperthyroidism, especially in the United States 3. It involves the use of radioactive iodine to ablate the thyroid gland and reduce hormone production. RAI is well tolerated, but it can cause hypothyroidism as a long-term sequelae 4.
Surgery
Surgery, either subtotal or near-total thyroidectomy, is a treatment option for hyperthyroidism, especially in patients with large goiters or those who cannot tolerate ATDs or RAI 5, 4. The goal of surgery is to cure the underlying pathology while leaving residual thyroid tissue to maintain postoperative euthyroidism 4.
Other Treatment Options
Other treatment options for hyperthyroidism include beta-blockers, which are used to control symptoms such as nervousness, tremors, and palpitations 6. Beta-blockers can also reduce the frequency of paralysis in patients with thyrotoxic periodic paralysis and improve sweating and myopathy.
Considerations for Treatment
The choice of treatment for hyperthyroidism depends on various factors, including the underlying diagnosis, the presence of contraindications, the severity of hyperthyroidism, and the patient's preference 3, 7. Treatment choices should be individualized and patient-centered, taking into account the patient's overall condition, comorbidities, and the potential risks and benefits of each treatment option 5, 7.