Overview of management of primary hyperthyroidism

Primary hyperthyroidism (ie Graves disease, toxic multinodular goitre, toxic adenoma) is usually managed initially with an antithyroid drug with the aim of achieving euthyroidism; see Antithyroid drug therapy for primary hyperthyroidism for more information. Some patients can achieve remission with an antithyroid drug alone (eg patients with mild Graves disease), while other patients use an antithyroid drug in preparation for definitive treatment (ie radioiodine or thyroidectomy). For more information about treatment following initial antithyroid therapy, see Subsequent management of primary hyperthyroidism.

Antithyroid drugs gradually relieve the symptoms of thyrotoxicosis as the patient becomes euthyroid. In the interim, beta-blocker therapy can be used for symptomatic patients to rapidly improve symptoms. See Beta blockers for symptoms of thyrotoxicosis for more information.

Acute, severe symptoms (eg fever, tachycardia, vomiting, dehydration, delirium or coma, organ system dysfunction) indicate thyroid storm; this is a medical emergency requiring immediate hospitalisation and treatment.

For management of other causes of thyrotoxicosis, see subacute thyroiditis, amiodarone-induced thyrotoxicosis or postpartum thyroiditis. See also Overview of thyrotoxicosis  for a summary of causes of thyrotoxicosis, and their presentation and management.

For information about the management of hyperthyroidism in pregnancy, see here.