Graves' disease hyperthyroidism medical therapy

{Graves' disease} Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Hyperthyroidism Therapy

Genreral aspects

• In a small proportion of patients, spontaneous remission occurs.
• Smoking cessation is one of the main stays of treatment.
• Antithyroid drugs are the first line treatment in Europe.
• Ablation therapy either by thyroidectomy or radioactive iodine is more accepted in North America.
• Each treatment approach has advantages and drawbacks. The patient’s preference, after receiving adequate counseling, remains a critical factor in therapy decisions.

The following table summarizes the medical therapy and surgical option for treatment.

Treatment	Mechanism	Route of administration	Advantages	Disadvantages	Special considerations
Beta-blockers	Block β-adrenergic receptors; propranolol may block conversion of T4 to T3	Oral; may be administered intravenously in acute cases	Ameliorates sweating, anxiety, tremulousness, palpitations, and tachycardia	Does not influence course of disease Use cautiously in patients with asthma, CHF , bradyarrhythmias or Raynaud’s phenomenon	Use cardioselective beta-blockers, especially in patients with COPD Use calcium-channel blockers as alternative