The recommended treatment for hyperthyroidism depends on the underlying cause and the patient's specific circumstances. The main treatment options include antithyroid drugs, radioactive iodine therapy, and surgery
Antithyroid drugs
- General principles: Antithyroid drugs are commonly used in the treatment of hyperthyroidism. A baseline complete blood count (CBC) and liver profile are recommended before initiating therapy
- Graves' disease: For patients with overt Graves' hyperthyroidism, antithyroid drugs are one of the recommended treatment modalities
- Thyroid storm: In the case of a thyroid storm, antithyroid drugs such as methimazole or propylthiouracil are recommended
- Amiodarone-induced hyperthyroidism: For most patients with type 1 amiodarone-induced thyrotoxicosis, antithyroid drugs are the medical treatment of choice
Radioactive iodine therapy
- Graves' disease: Radioactive iodine therapy is one of the recommended treatment modalities for patients with overt Graves' hyperthyroidism
- Toxic goiter and adenoma: For patients with toxic multinodular goiter, sufficient activity of radioactive iodine should be administered in a single application to alleviate hyperthyroidism
- Amiodarone-induced hyperthyroidism: In patients with amiodarone-induced thyrotoxicosis, ablation of a hyperfunctioning thyroid gland with radioactive iodine therapy is recommended
Surgery
- Graves' disease: If surgery is chosen as the primary therapy for Graves' disease, near-total or total thyroidectomy is the procedure of choice
- Amiodarone-induced hyperthyroidism: In patients with amiodarone-induced thyrotoxicosis, elective thyroidectomy is recommended for the ablation of a hyperfunctioning thyroid gland
Other considerations
- Subclinical hyperthyroidism: Treatment is recommended for subclinical hyperthyroidism when TSH is persistently < 0.1 mU/L in certain clinical settings, such as patients ≥ 65 years of age, patients with cardiac risk factors, heart disease or osteoporosis, postmenopausal women who are not on estrogens or bisphosphonates, and patients with symptoms
- Potassium iodide: There is insufficient evidence to recommend potassium iodide for the treatment of hyperthyroidism. However, it may be of benefit in select patients with hyperthyroidism due to Graves' disease, those who have adverse reactions to antithyroid drugs, and those who have a contraindication or aversion to radioactive iodine therapy or surgery
In summary, the recommended treatment for hyperthyroidism involves a tailored approach based on the underlying cause and the patient's individual circumstances. The main treatment options—antithyroid drugs, radioactive iodine therapy, and surgery—are selected considering factors such as the type of hyperthyroidism, patient age, comorbidities, and preferences.