Endocrinology Book

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Hyperthyroidism Management

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  1. See Also
    1. Thyroid Storm
    2. Hyperthyroidism
    3. Grave's Disease
    4. Subclinical Hyperthyroidism
  2. Medications: Antiadrenergic Medications
    1. Indications
      1. Thyroiditis
      2. Concurrent initially with ablation, PTU/MTZ, surgery
      3. Symptomatic control
        1. Controls Tremor, Palpitations, nervousness
    2. Beta Blockers (non-selective preferred)
      1. Propranolol
        1. Start: 10-20 mg PO q6 hours
        2. Advance to 20 to 80 mg PO q6 hours
    3. Diltiazem (Cardizem)
      1. Alternative if Beta Blockers not tolerated
  3. Medications: Antithyroid Medications
    1. Indications
      1. Hyperthyroidism in children and adolescents
      2. Pregnancy (PTU)
      3. Severe Grave's Disease
    2. Antithyroid Medications
      1. Methimazole 15-30 mg per day
      2. Propylthiouracil (PTU) 100-200 mg PO tid
        1. Indicated in pregnancy
    3. Monitoring
      1. See Antithyroid Medications
  4. Management: Ablation
    1. Radioactive Iodine
      1. Management of choice for Grave's Disease of all ages
      2. Recurrent Hyperthyroidism after Antithyroid Drugs
      3. Toxic Multinodular Goiter
      4. Toxic Nodule in patient over age 40 years
    2. Subtotal Thyroidectomy
      1. Pregnancy
      2. Children intollerant to antithyroid medications
      3. Toxic Nodule under age 40 years
      4. Large Thyroid Goiter causing local compression
    3. Monitoring after ablation
      1. Thyroid Stimulating Hormone may not be accurate
      2. Follow Free T4, Free T3 to base Thyroid Replacement
  5. References
    1. Ginsberg (2003) CMAJ 168:575
    2. Reid (2005) Am Fam Physician 72:623

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