Hyperthyroidism Treatment Options: Medications, Radioiodine, Surgery, and More

Treatment for overactive thyroid (Graves’ disease, toxic nodular goiter, thyroiditis) is individualized.

1. Antithyroid Drugs (ATDs)

• Methimazole (MMI): First‑line (except first trimester pregnancy). Inhibits thyroid peroxidase. Dose 15–30 mg/day, then taper. Monitor CBC/LFTs (rare agranulocytosis, hepatotoxicity).
• Propylthiouracil (PTU): Preferred in first trimester; also inhibits peripheral T4→T3 conversion. Higher hepatotoxicity risk.

2. Radioactive Iodine (RAI, I‑131)

• Ablates thyroid tissue; definitive. Contraindicated in pregnancy/lactation.
• May worsen Graves’ ophthalmopathy (give steroids if moderate/severe).
• Leads to hypothyroidism → lifelong levothyroxine.

3. Beta‑Blockers

• Propranolol, atenolol: control tachycardia, tremor, anxiety while ATDs/RAI take effect.

4. Thyroidectomy

• Total or near‑total. Indicated for large goiter, compressive symptoms, suspicious nodules, pregnancy (if ATD intolerant), or patient preference.
• Risks: recurrent laryngeal nerve injury, hypoparathyroidism. Requires experienced surgeon.

5. Post‑Ablation/Surgery

Levothyroxine replacement with monitoring (TSH, free T4).

Choice depends on etiology, severity, age, comorbidities, pregnancy, and patient values. Shared decision‑making is essential.