Treatment-hyperthyroidism

• β-blockers: control tachycardia (propranolol also ↓ T4 → T3 conversion)
• Graves’ disease: either antithyroid drugs or radioactive iodine (NEJM 2016;375:1552) methimazole: 60% chance of recurrence after 1 y; side effects include pruritus, rash, arthralgia, fever, N/V and agranulocytosis in 0.5%. PTU: 2nd line (risk of hepatocellular necrosis; TID dosing; slower effect; JCEM 2007;92:2157). For both, need to ✓ LFTs, WBC, TSH at baseline and in follow-up. radioactive iodine (RAI) (NEJM 2011;364:542): typically done as outPt; preRx w/ antithyroid drugs in selected Pts w/ CV disease or elderly to prevent ↑ thyrotoxicosis, stop 3 d before to allow RAI uptake; >75% of treated Pts become hypothyroid surgery: less commonly chosen for Graves’, usually for Pts w/ obstructive goiter or ophthalmopathy. Adverse effects hypoparathyroidism, recurrent laryngeal nerve injury.
• Ophthalmopathy: can worsen after RAI; prophylax w/ prednisone in high-risk Pts; can be Rx’d w/ selenium, glucocorticoids, teprotumumab (IGF-1R inhibitor), radiation and/or surgical decompression of orbits (NEJM 2009;360:994)
• Toxic adenoma or toxic multinodular goiter: RAI or surgery (methimazole preRx for surgery, in selected patients before RAI)