From the Guidelines
Hyperthyroidism is typically treated with antithyroid medications, such as methimazole, or nonreversible thyroid ablation therapy, including radioactive iodine or surgery, especially 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. The treatment approach for hyperthyroidism depends on confirming the diagnosis with additional thyroid function tests, particularly free T4 and free T3 levels.
- If these tests confirm hyperthyroidism, treatment options include:
- Anti-thyroid medications like methimazole (starting at 5-10 mg daily) or propylthiouracil (50-150 mg three times daily)
- Radioactive iodine therapy
- Surgery in certain cases
- Beta-blockers such as propranolol (10-40 mg three to four times daily) may be prescribed to manage symptoms like rapid heart rate and anxiety while awaiting definitive treatment.
- The underlying cause of hyperthyroidism (Graves' disease, toxic nodular goiter, thyroiditis) should be determined as it affects treatment approach.
- Regular monitoring of thyroid function is essential during treatment, typically every 4-6 weeks initially.
- Some cases of mild subclinical hyperthyroidism may only require monitoring without immediate intervention, especially if the patient is asymptomatic.
- Consultation with an endocrinologist is recommended for proper diagnosis and personalized treatment planning.
From the FDA Drug Label
Propylthiouracil inhibits the synthesis of thyroid hormones and thus is effective in the treatment of hyperthyroidism. Methimazole inhibits the synthesis of thyroid hormones and thus is effective in the treatment of hyperthyroidism. The treatment for hyperthyroidism (low Thyroid-Stimulating Hormone (TSH)) is propylthiouracil or methimazole, which inhibit the synthesis of thyroid hormones 2, 2, 3.
- Propylthiouracil is effective in the treatment of hyperthyroidism and may also be used to treat thyroid storm.
- Methimazole is also effective in the treatment of hyperthyroidism.
From the Research
Treatment Options for Hyperthyroidism
The treatment for hyperthyroidism, characterized by low Thyroid-Stimulating Hormone (TSH) levels, depends on the underlying cause and severity of the condition. The following options are available:
- Antithyroid medications, such as methimazole and propylthiouracil, to reduce thyroid hormone production 4, 5, 6, 7
- Radioactive iodine ablation of the thyroid gland, which is the most widely used treatment in the United States 4, 6, 7
- Surgical thyroidectomy, which may be considered for patients with large goiters or those who cannot tolerate antithyroid medications or radioactive iodine 4, 5, 7
Considerations for Treatment Choice
The choice of treatment depends on various factors, including:
- The underlying diagnosis, such as Graves' disease, toxic multinodular goiter, or toxic adenoma 4, 5, 6, 7
- The presence of contraindications to a particular treatment modality 4
- The severity of hyperthyroidism 4, 5, 6, 7
- The patient's preference 4
- The risk of recurrence, which is higher in patients with Graves' disease who are younger than 40 years, have higher FT4 concentrations, or have larger goiters 5
Special Considerations
Certain patient populations require special consideration, such as:
- Pregnant women, who may require close monitoring and adjustment of treatment 5, 6
- Patients with COVID-19, who may be at increased risk of complications 5
- Patients with other complications, such as atrial fibrillation, thyrotoxic periodic paralysis, or thyroid storm, which require prompt treatment 5, 6, 7