From the Guidelines
Hyperthyroidism is treated with antithyroid medications, such as methimazole, or nonreversible thyroid ablation therapy, including radioactive iodine or surgery, particularly for patients with a TSH level that is undetectable or less than 0.1 mIU/L, especially those with overt Graves disease or nodular thyroid disease 1. The main treatments for hyperthyroidism include:
- Anti-thyroid medications like methimazole (10-30mg daily) or propylthiouracil (100-300mg daily in divided doses), which block thyroid hormone production and typically show improvement within 2-6 weeks, with treatment lasting 12-18 months.
- Radioactive iodine therapy (I-131) that permanently destroys overactive thyroid cells, requiring a single oral dose with effects appearing within 3-6 months.
- Surgical removal of part or all of the thyroid gland (thyroidectomy) may be recommended, especially for large goiters or when medications aren't tolerated.
- Beta-blockers such as propranolol (10-40mg, 3-4 times daily) can provide symptom relief while waiting for other treatments to work. The choice of treatment depends on factors including the patient's age, pregnancy status, severity of hyperthyroidism, and underlying cause. After treatment, regular thyroid function monitoring is essential as many patients eventually develop hypothyroidism requiring thyroid hormone replacement. Lifestyle modifications like stress reduction and avoiding iodine-rich foods can complement medical treatment by helping to manage symptoms. It's also important to note that treatment is typically not recommended for patients with TSH levels between 0.1 and 0.45 mIU/L or when thyroiditis is the cause 1. In pregnancy, hyperthyroidism is treated with a thioamide (propylthiouracil or methimazole) and the goal is to maintain FT4 or FTI in the high-normal range using the lowest possible thioamide dosage 1.
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 (excessive production of thyroid hormone) includes the use of medications such as:
- Propylthiouracil (PO) 2
- Methimazole (PO) 3 These medications inhibit the synthesis of thyroid hormones, making them effective in the treatment of hyperthyroidism.
From the Research
Treatment Options for Hyperthyroidism
The treatment for hyperthyroidism, a condition characterized by excessive production of thyroid hormone, can vary depending on the underlying cause, severity, and patient preference. The following are some of the treatment options available:
- Antithyroid medications, such as methimazole and propylthiouracil, which inhibit thyroid hormone synthesis 4, 5, 6, 7, 8
- Radioactive iodine ablation of the thyroid gland, which is the most widely used treatment in the United States 5, 8
- Surgical thyroidectomy, which involves the removal of part or all of the thyroid gland 5, 8
Antithyroid Medications
Antithyroid medications, such as methimazole and propylthiouracil, are commonly used to treat hyperthyroidism. These medications work by inhibiting the synthesis of thyroid hormone at different steps. Methimazole is often the drug of choice due to its widespread availability, longer half-life, and lower risk of severe side effects 4, 6. The starting dose of methimazole is typically 10-30 mg per day, while propylthiouracil is usually started at a dose of 100-300 mg every 6 hours 4.
Treatment Considerations
The choice of treatment for hyperthyroidism depends on various factors, including the underlying diagnosis, presence of contraindications, severity of hyperthyroidism, and patient preference 5, 8. In pregnant women, propylthiouracil is often the preferred treatment due to its lower risk of congenital anomalies 4. In patients with subclinical hyperthyroidism, treatment may not always be necessary, but close monitoring is recommended to prevent disease complications or progression to overt hyperthyroidism 7, 8.