Hyper4

• Medical Treatment

  • Antithyroid drugs
  • b-blockers
  • Steroids for Graves ophthalmopathy
• Antithyroid drugs

  Thionamides (e.g. propylthiouracil, methimazole) that inhibit iodide organification and iodotyrosine coupling and decrease the conversion of T4 to T3
• Side effects of antithyroid drugs

  • Agranulocytosis
  • Arthralgia
  • Headaches
  • Cholestasis
  • Dependent edema
  • Neuritis
  • Rash
  • Nausea/vomiting
  • Hepatotoxicity
  • Jaundice
• 1. blockers (e.g. propranolol)

  Used for rapid symptomatic relief by blocking peripheral conversion of T4 to T3, not used alone unless self-limiting condition
• Radiotherapy (Radionucleotide ablation with 131I)

  1. Destroys thyroid cells rather than alters their DNA

  2. May need multiple doses

  3. May worsen eye symptoms in Graves' disease

  4. Contraindicated in pregnancy, breastfeeding, urinary incontinence

  5. Pregnancy should be delayed 4-6 months after radioiodine therapy

  6. Free T4, total T3, & TSH are measured 4-6 weeks after radioiodine therapy

  7. If patient becomes and remains euthyroid for 6 months, serum TSH should be measured at 6-12 month intervals for lifetime

  8. If patient becomes hypothyroid, thyroid hormone should be started

  9. Once euthyroidism is achieved on a stable dose of thyroid hormone replacement, TSH can be measured annually
• Surgical Treatment

  Total thyroidectomy
• Indications for total thyroidectomy

  • Pregnancy
  • Inability to comply with or failure of medical therapy
  • Suspicion of malignancy
  • Large goiter causing compressive symptoms (dysphagia, dysphonia, dyspnea)
  • Cosmetic