Box 3.19Treatments of hyperthyroidism

DrugUseAdvantagesDisadvantages/side effects
Thiocarbamides e.g. PTU, carbimazolePatients with mild thyroid disease and small goiter or those with eye disease, cardio-respiratory disease, pregnancy, childrenCheap, effectiveRashes, pruritis (~ 4%), neutropenia (~ 0.4%), hepatitis or pneumonitis (~ <0.1%)
β-adrenergic receptor blockers (e.g. propranolol)Symptomatic relief (especially cardiac), hyperthyroid stormPropranolol inhibits hepatic conversion of T4 to T3Asthma, heart failure
Glucocorticoids (e.g. prednisolone)Hyperthyroid stormPrednisolone inhibits hepatic conversion of T4 to T3Iatrogenic Cushing's syndrome
Iodine (e.g. Lugol's solution)Hyperthyroid storm Prior to surgery to reduce blood flowRapid inhibition of thyroid hormone synthesis (Wolff-Chaikoff effect)‘Escape’ occurs with time
PerchlorateIodine-induced hyperthyroidismDischarge iodide excess from thyroid glandRash, gastric upset, lymphadenopathy (~ 5%). Agranulocytosis or aplastic anaemia (~ 0.5%)
LithiumSecond-line alternative to thiocarbamidesInhibits T4 and T3 releaseLithium toxicity* (tremor, ataxia, coma); polydipsia, polyuria (~10%)
ProcedureUseAdvantagesDisadvantages/side effects
Partial thyroidectomyPatients with large goiter, severe disease, nodular disease, relapsed after medical treatment‘Definitive’Expensive and scarring. Recurrent laryngeal nerve palsy (~ 0.5%) hypoparathyroidism (~ 5%), hypothyroidism (~ 5–40%), recurrent hyperthyroidism (~ 5%), carotid/jugular damage and hemorrhage (~ 0.5%). Relative contraindications include previous surgery and pregnancy
ProcedureUseAdvantagesDisadvantages/side effects
131IodinePatients with cardio-respiratory disease, severe disease, previous thyroid surgery, toxic noduleCheap, effective, shrinks goiter without a scarSialadenitis, worsening eye disease, hypothyroidism.
Absolute contraindication: pregnancy. Relative contraindication: youth and eye disease — many clinicians do not treat <18 years old and eye disease may be treated with glucocorticoids

Lithium toxicity is related to the blood concentration of the ion.

From: Chapter 3, The thyroid gland

Cover of Endocrinology
Endocrinology: An Integrated Approach.
Nussey S, Whitehead S.
Copyright © 2001, BIOS Scientific Publishers Limited.

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