Treatment of Hyperthyroidism: Antithyroid Drugs
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Treatment of Hyperthyroidism: Antithyroid Drugs

Which therapy is best is a matter of debate. There is no one best treatment. The choice of therapy largely depends on physician experience and the patientÂ’s preferences.
     antithyroid drugs (ATD) treatment of hyperthyroidism

Image Source - Antithyroid Drugs

• Antithyroid drugs (ATD)

Propylthiouracil (PTU)

Methimazole (Tapazole or MMI)

• Radioactive iodine

• Surgery

Which therapy is best is a matter of debate. There is no one best treatment. The choice of therapy largely depends on physician experience and the patient’s preferences. The principal objective is to alleviate the thyrotoxicosis and its attendant symptoms.

Anti-thyroid Drugs

• ATDs are chiefly used for long-term treatment of patients with Graves disease

ATDs are preferred for pregnant women, children, adolescents, before surgery, and prior to radioactive iodine therapy

PTU is the preferred drug during pregnancy, lactation, and for thyroid storm

MMI will more rapidly normalize the T4 and T3

PTU is supplied as a 50 mg tablet and the usual starting dose is 100 mg three times a day

MMI is supplied as 5 or 10 mg tablet and the usual starting dose is 30 mg daily.

Factors that determine the speed of recovery

Disease activity

Initial degree of hyperthyroidism

Intrathyroidal stores of T4 and T3, which correlates with the size of the thyroid gland

• Factors that favor a sustained remission after ATD:

T3-toxicosis

Small goiter

Decrease in size of the goiter during therapy

Normal thyroid function tests

Normal TSH

Negative tests for thyroid-stimulating immunoglobulin

The presence of HLA-DR4

Duration of antithyroid drug therapy

Amount of the medication needed to control the

Hyperthyroidism

• Clinical considerations during ATD therapy

Patients should be seen every 6 weeks if they are not pregnant and every 4 weeks if they are pregnant

Patients are usually euthyroid in 6 to 12 weeks

The dose of ATD should be decreased progressively as the hyperthyroidism subsides

A reasonable rule of thumb is to decrease the dose by 25% to 33% each visit if the free T4 and free

T3 are normal.

The free T4 and free T3 are the best tests to monitor during ATD therapy. The TSH may remain low for months after the free T4 and free T3 are normal.

The dose of ATD is decreased to the lowest dose that maintains the free T4 and free T3 within the normal range.

ATDs are discontinued after 12 to 24 months of control of the hyperthyroidism

Most relapses occur within the first year off the

ATDs

Rate of recurrent thyrotoxicosis plateaus at 50% at year 5 following discontinuation of the ATD Lifelong follow-up for all patients with Graves disease is essential because hypothyroidism may occur years after successful ATD treatment.

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