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Hyperthyroidism and Thyrotoxicosis

Updated : September 3, 2022





Background

Epidemiology

Anatomy

Pathophysiology

Etiology

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

methimazole 

Mild dose- 15 mg/day orally divided 3 times daily, depending on the severity of the condition
Moderate- Initially 30-40 mg/day orally divided 3 times daily
Severe- 60 mg/day orally divided 3 times daily
Maintenance dose- 5-30 mg/day orally divided 3 times daily
Thyrotoxicosis
(Off-label)
15-20 mg orally every 4 hours in the initial day as an adjunct
Reduce the frequency to each day or every 12 hours once patient gets stable



propylthiouracil 

300-450 mg orally divided every 8 hours, depending on the severity of the condition
(A dose of 600-900 mg/day maybe required)
Maintenance dose- 100-150 mg orally divided every 8 hours
Thyrotoxic Crisis
(Off-label)
Initially 200-300 mg orally every 4-6 hours on 1st day
Reduce the dose gradually
Maintenance dose- 100-150 mg/day divided 2-3 times daily



sodium iodide I-131 

4-10 mCi orally (or 148-370 MBq)
Larger doses are required in the case of toxic nodular goiters, and several other severe thyroid conditions



 

methimazole 

Initially 0.5-0.7 mg/kg orally each day or divided 3 times daily
Maintenance dose- 0.2 mg/kg orally each day or divided 3 times daily
Do not exceed more than 30 mg/day
Thyrotoxicosis
(Off-Label)
0.5-1 mg/kg orally divided 3 times daily
Based on the patient’s response, adjust the subsequent doses/duration of treatment



propylthiouracil 

Indicated in children for hyperthyroidism only
For neonates, less than 28 days old: 5-10 mg/kg orally divided 3 times daily
For <6 years: 5-7 mg/kg orally divided 3 times daily
For 6-10 years: 50-150 mg orally divided 3 times daily
For >10 years: 150-300 mg orally divided daily
Maintenance dose: Usually one to two third of the intial dose 2-3 times daily based on the response



 

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References

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Hyperthyroidism and Thyrotoxicosis

Updated : September 3, 2022




methimazole 

Mild dose- 15 mg/day orally divided 3 times daily, depending on the severity of the condition
Moderate- Initially 30-40 mg/day orally divided 3 times daily
Severe- 60 mg/day orally divided 3 times daily
Maintenance dose- 5-30 mg/day orally divided 3 times daily
Thyrotoxicosis
(Off-label)
15-20 mg orally every 4 hours in the initial day as an adjunct
Reduce the frequency to each day or every 12 hours once patient gets stable



propylthiouracil 

300-450 mg orally divided every 8 hours, depending on the severity of the condition
(A dose of 600-900 mg/day maybe required)
Maintenance dose- 100-150 mg orally divided every 8 hours
Thyrotoxic Crisis
(Off-label)
Initially 200-300 mg orally every 4-6 hours on 1st day
Reduce the dose gradually
Maintenance dose- 100-150 mg/day divided 2-3 times daily



sodium iodide I-131 

4-10 mCi orally (or 148-370 MBq)
Larger doses are required in the case of toxic nodular goiters, and several other severe thyroid conditions



methimazole 

Initially 0.5-0.7 mg/kg orally each day or divided 3 times daily
Maintenance dose- 0.2 mg/kg orally each day or divided 3 times daily
Do not exceed more than 30 mg/day
Thyrotoxicosis
(Off-Label)
0.5-1 mg/kg orally divided 3 times daily
Based on the patient’s response, adjust the subsequent doses/duration of treatment



propylthiouracil 

Indicated in children for hyperthyroidism only
For neonates, less than 28 days old: 5-10 mg/kg orally divided 3 times daily
For <6 years: 5-7 mg/kg orally divided 3 times daily
For 6-10 years: 50-150 mg orally divided 3 times daily
For >10 years: 150-300 mg orally divided daily
Maintenance dose: Usually one to two third of the intial dose 2-3 times daily based on the response



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