MANAGEMENT

• Goal: restoration of clinical and biochemical euthyroid state by omitting or reducing the dosage of medications and other measures as needed depending on clinical status.

• ECG• Blood test: TSH, T3, T4 levels, monitored regularly

• SYMPTOMATIC TREATMENT: • To control tachycardia, hypertension and atrial fibrillation:

20 - 40 mg doses of propranolo Q 6hours; d• If beta blockers are contraindicated: Diazepam and/or

chlorpromazine

• RADIOACTIVE IODINE– ingestion of a radioactive iodine tablet (6-12 wks) which is

then taken up by thyroid cells. These overactive cells are destroyed so that the thyroid can shrink in size and produce hormone at normal levels.

– In patients with underlying heart disease and in elderly patients, it is desirable to treat with antithyroid drugs (methimazole) until the patient is euthyroid. The medication is then stopped for 5-7days before the appropriate dosage of 131I.

– Although it is a safe treatment, most people become hypothyroid after radioactive iodine therapy and therefore require lifelong thyroid hormone replacement therapy.

• THYROIDECTOMY– Now uncommonly performed; the surgeon removes most or all of

the gland– Candidates for surgery: include pregnant hyperthyroid patients

intolerant of anti-thyroid drugs, patients desiring definitive therapy without the use of radioactive iodine, children, and patients with very large or multinodular goiters.

– Patients are treated with antithyroid drugs until euthyroid (about 6wks). In addition, 10-14 days prior to surgery, they receive saturated solution of potassium iodide 5 drops BID, to diminish vascularity of the gland and simplify surgery

– However, in cases of total removal of the thyroid gland, patient must take thyroid replacement pills for the rest of his or her life

NON-PHARMACOLOGICAL

• High calorie diet in order to replace all the energy burned by the body in hyperthyroid state

• Drink plenty of water and juices to replace all the fluid losses. Avoid or limit caffeinated drinks for such could produce anxiety.