From the Guidelines
Hyperthyroidism should be treated with antithyroid medications, such as methimazole or propylthiouracil, to reduce thyroid hormone production and alleviate symptoms, as recommended by the most recent guidelines 1. The primary goal of treatment is to manage symptoms, prevent long-term complications, and improve quality of life.
Symptoms of Hyperthyroidism
- Weight loss
- Rapid heart rate
- Tremors
- Heat intolerance
- Anxiety
- Fatigue
Treatment Options
- Antithyroid medications: methimazole (10-30 mg daily) or propylthiouracil (100-300 mg daily divided into multiple doses) to block hormone production 1
- Beta-blockers: propranolol (20-40 mg every 6-8 hours) to manage symptoms like rapid heart rate and tremors
- Radioactive iodine therapy or thyroid surgery (thyroidectomy) for patients who don't respond to medication or have severe disease
Monitoring and Follow-up
- Regular monitoring of thyroid function every 4-6 weeks initially, then every 2-3 months once stabilized
- Patients should watch for side effects of antithyroid medications, particularly rash, fever, sore throat, or jaundice, which could indicate serious complications requiring immediate medical attention
Importance of Treatment
Hyperthyroidism requires treatment because untreated disease can lead to serious complications, including:
- Heart problems
- Bone loss
- Thyroid storm—a life-threatening condition characterized by extremely high body temperature, rapid heart rate, and potential heart failure Treatment should be individualized, and patients should be closely monitored to minimize the risk of complications and improve quality of life 1.
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. Patients who receive propylthiouracil should be under close surveillance and should be counseled regarding the necessity of immediately reporting any evidence of illness, particularly sore throat, skin eruptions, fever, headache, or general malaise.
The symptoms of Hyperthyroidism that are mentioned in the context of propylthiouracil treatment include:
- Sore throat
- Skin eruptions
- Fever
- Headache
- General malaise
- Anorexia
- Pruritus
- Jaundice
- Light colored stools
- Dark urine
- Right upper quadrant pain
Treatment options for Hyperthyroidism mentioned in the drug labels include:
- Propylthiouracil
- Methimazole
- Thyroid surgery
- Radioactive iodine therapy
- Beta-adrenergic blocking agents
- Digitalis glycosides
- Theophylline
It is recommended that patients with hyperthyroidism be closely monitored and that treatment be adjusted as necessary to achieve a sufficient but not excessive dose 2, 2, 3.
From the Research
Symptoms of Hyperthyroidism
- Nervousness, heat intolerance, weight loss, and fatigue are common symptoms of hyperthyroidism 4
- Anxiety, insomnia, palpitations, unintentional weight loss, diarrhea, and heat intolerance are also symptoms of thyrotoxicosis 5
- Patients with Graves disease may have a diffusely enlarged thyroid gland, stare, or exophthalmos on examination 5
- 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 5
Treatment Options for Hyperthyroidism
- Antithyroid medications (methimazole and propylthiouracil) can be used to treat hyperthyroidism caused by overproduction of thyroid hormones 6, 7
- Radioactive iodine ablation of the thyroid gland is a widely used treatment in the United States 6, 8, 5
- Surgical thyroidectomy is also a treatment option for hyperthyroidism 6, 8, 5
- Beta blockers can be used to treat cardiovascular manifestations such as hypertension and tachycardia 8
- Treatment choices should be individualized and patient centered, taking into account the underlying diagnosis, presence of contraindications, severity of hyperthyroidism, and patient preference 6, 5
Management of Subclinical Hyperthyroidism
- Subclinical hyperthyroidism is not always treated, although close monitoring is needed to prevent disease complications or progression to overt hyperthyroidism 4
- 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 4, 5
- Treatment options for subclinical hyperthyroidism include antithyroid drugs and radioactive iodine ablation 4, 5
Complications of Untreated Hyperthyroidism
- Untreated hyperthyroidism can cause cardiac arrhythmias, heart failure, osteoporosis, and adverse pregnancy outcomes 5
- It may lead to unintentional weight loss and is associated with increased mortality 5
- Thyroid storm is a life-threatening complication of unmanaged or inadequately managed hyperthyroidism that warrants urgent treatment in a hospital setting 8, 4