Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

772 Hyperthyroidism

management

What to Do First

■Assess severity by clinical toxicity, extent of free T4 and T3 elevation

General Measures

■Assess for associated disorders such as cardiovascular disease, infec-

tions

specific therapy

■Beta-blockade: propranolol, metoprolol, atenolol: for all causes of

symptomatic hyperthyroidism; dose depends on degree of severity

■I-131: useful for uncomplicated GD, MNTG, toxic adenoma of mild

to moderate severity

■Propylthiouracil (PTU) or methimazole (MTZ): useful for GD, MNTG,

toxic adenoma, esp when complicated by pregnancy, heart disease,

or severe illness

■Thyroid surgery: in pregnancy, toxic adenoma, amiodarone-induced

hyperthyroidism when other therapies fail

■NSAIDs: for treatment of DeQuervain’s thyroiditis, prednisone in

severe cases

■Saturated potassium iodide (SSKI): in GD when mild or as adjunct

after I-131 treatment, in thyroid storm

■Side Effects

■I-131: hypothyroidism, infrequent radiation thyroiditis, rare thyroid

storm

■PTU or MTZ: common allergic reactions such as rash, infrequent

agranulocytosis, rare liver toxicity

■Thyroid surgery: hypoparathyroidism, recurrent laryngeal nerve

injury, thyroid storm if not euthyroid at time of surgery

follow-up

During Treatment

■Initially: assessment of thyroid status q 1–2 mo by clinical exam and

serum free T4 or total T3

■Eventually: assessment by exam and serum TSH with free T4

Routine

■Ultimately: annual assessment of thyroid status; if taking PTU or

MTZ, obtain CBC if patient develops sore throat or fever to rule out

agranulocytosis