2 min read - Thyrotoxicosis treatment

Treatment of thyrotoxicosis has several aspects

1. Symptomatic relief

  • Beta-blockers are the first line.
  • Beta-blockers can be started even before the diagnosis is confirmed. When you suspect thyrotoxicosis start beta-blockers before reviewing the patient with TSH and Free T4 reports.
  • The usual dose is Propranolol 20-40mg three to four times a day.
  • Make sure the patient does not have bronchial asthma!
2. Reduce thyroid hormone synthesis
  • Thionamides are safe and have a quick onset of action
  • Carbimazole is the commonly used drug
  • The usual dose is 10mg three times a day, but according to the initial Free T4 level, the dose can be adjusted.
  • The maintenance dose should be continued for a year or two before considering stopping the treatment.
  • Many patients will relapse requiring other definitive treatments

  • MCQ tip
    • Agranulocytosis is a 'favorite' complication of thionamides
    • The patient should be advised to stop taking carbimazole and immediately come to the hospital if he/she develops 
    • Some can develop pancytopenia and spontaneous bleeding could be the manifestation
3. Radioiodine ablation
  • a therapeutic dose of I131 can cure thyrotoxicosis in a majority of thyrotoxic patients. Some of them will become hypothyroid later requiring thyroid hormone replacement

  • Essay questions regarding preparation for radioiodine treatment and contraindications are common. Better have them read!
4. Thyroidectomy
  • Before thyroidectomy patient should be made euthyroid by medical treatment.
  • There are few definite indications for thyroidectomy. Read them up!
5. Treatment of thyroid eye disease
  • Points that you should know are
    • Steroids can be used for treatment
    • Some treatments like radioiodine can worsen thyroid eye disease
6. Monitoring
  • Assess patients clinical symptoms
  • Document pulse rate
  • Measure weight during each visit

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