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, as recommended by the USPSTF 1. The primary treatments for hyperthyroidism include:
- Antithyroid medications like methimazole (starting at 5-30 mg daily) or propylthiouracil (50-300 mg daily in divided doses), which block thyroid hormone production and typically show improvement within 2-4 weeks.
- Beta-blockers such as propranolol (20-40 mg 3-4 times daily) or atenolol (25-100 mg daily) can quickly relieve symptoms like rapid heartbeat and tremors while waiting for other treatments to work.
- Radioactive iodine therapy (I-131) is often used as a definitive treatment, destroying overactive thyroid cells over 6-18 weeks.
- Surgical removal of part or all of the thyroid (thyroidectomy) may be necessary in cases of large goiters, pregnancy when medications aren't tolerated, or cancer suspicion. After radioactive iodine or surgery, many patients develop hypothyroidism and require lifelong levothyroxine replacement. Treatment choice depends on factors including the patient's age, pregnancy status, severity of hyperthyroidism, and underlying cause, with Graves' disease, toxic nodules, and thyroiditis each potentially requiring different approaches. Regular monitoring of thyroid function tests is essential throughout treatment to adjust medication dosages appropriately, as recommended by the USPSTF 1.
From the FDA Drug Label
Propylthiouracil is indicated: in patients with Graves’ disease with hyperthyroidism or toxic multinodular goiter who are intolerant of methimazole and for whom surgery or radioactive iodine therapy is not an appropriate treatment option. Propylthiouracil is used to decrease symptoms of hyperthyroidism in preparation for a thyroidectomy (removal of the thyroid gland) or radioactive iodine therapy.
The treatment options for hyperthyroidism include:
- Propylthiouracil: for patients with Graves’ disease with hyperthyroidism or toxic multinodular goiter who are intolerant of methimazole
- Surgery: thyroidectomy (removal of the thyroid gland)
- Radioactive iodine therapy: to decrease symptoms of hyperthyroidism 2 2 2
From the Research
Treatment Options for Hyperthyroidism
The treatment options for hyperthyroidism include:
- Anti-thyroid medications, such as methimazole and propylthiouracil, which can be used temporarily or long-term 3, 4, 5, 6
- Radioactive iodine ablation of the thyroid gland, which is the most widely used treatment in the United States 3, 4, 7
- Surgical thyroidectomy, which can be considered for patients with concurrent cancer, pregnancy, compressive symptoms, or Graves' disease with ophthalmic manifestations 3, 4, 7
Factors Influencing Treatment Choice
The choice of treatment depends on:
- The underlying diagnosis, such as Graves' disease, toxic multinodular goiter, or toxic adenoma 3, 4
- The presence of contraindications to a particular treatment modality 4
- The severity of hyperthyroidism 4
- The patient's preference 4
Efficacy of Treatment Options
- Methimazole has been shown to be more effective than propylthiouracil in inducing euthyroidism in patients with Graves' hyperthyroidism 5, 6
- Radioactive iodine ablation has been shown to be effective in treating hyperthyroidism, but may have long-term consequences, such as the need for levothyroxine supplementation 7
- Surgical thyroidectomy has been shown to be effective in treating hyperthyroidism, with a high remission rate and low recurrence rate 7