1.  Diagnosis:

Clinical presentation and initial biochemical evaluation should make the diagnosis in most cases.However, a case of a patient  with no goiter and no apparent eye disease may need more testing.The thyroid stimulating antibody TRAb,  iodine uptake, or ultrasound can be used. Thyroid scan is indicated if toxic adenoma or toxic multinodular goiter is suspected.

2. Use TRAb to control antithyroid drug therapy. 13% of patients have reactions. Minor allergic reactions to serious reactions that include a loss of white blood cells, blood vessel disease, and liver toxicity..

TRAb levels should be measured before the end of antithyroid drug therapy to identify patients with a higher chance of remission.¹

“Patients with high TRAb could opt for Surgery or radioiodine.

3. Safety of long-term antithyroid drug therapy makes it more accepted to be on antithyroid drugs long-term.

Methimazole doses of 2.5 mg/d to 10mg/d  is safe and effective and had  better outcomes and fewer side effects than radioiodine therapy.

4. Women pregnant with Hyperthyroidism

Patients should postpone pregnancy until they have normal blood tests.   There are potential maternal and fetal risks of both thyroid dysfunction and the medication.   Follow the antibodies throughout pregnancy in a woman.

5. Check Calcium and vitamin D prior to thyroid surgery because of postsurgical low calcium state called hypoparathyroidism. Oral supplementation reduced rates of postoperative hypocalcemia.  With pre-operative normal D levels, the patient had a lower chance of low calcium after surgery. Takng calcium in the 2 weeks before thyroidectomy prevented low calcium state post op.

Big problems still need answers

When to treat subclinical hyperthyroidism?

Better  treatment options for Thyroid Eye Disease TED.

www.thyroid.com

Richard Guttler MD,FACE,ECNU

RE: ATA guidelines for hyperthyroidism

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