Beta blockers for symptoms of thyrotoxicosis

Antithyroid drugs eventually relieve the symptoms of thyrotoxicosis as the patient becomes euthyroid. In the interim, a beta blocker can be used to rapidly improve some symptoms of thyrotoxicosis (eg palpitations, tremor, sweating). Beta blockers do not reduce the high metabolic state of thyrotoxicosis, so do not replace the need for an antithyroid drug.

For a patient with symptoms of thyrotoxicosis who is already taking a beta blocker for concurrent heart failure, only consider increasing the dose of the beta blocker if it is safe to do so, and do not add a second beta blocker. For patients taking a beta blocker for another indication, the dose can usually be increased safely. See Beta blockers for heart failure for more information.

Historically, propranolol has been used for thyrotoxicosis; however, most beta blockers provide adequate symptom relief. The most useful guide for dose titration is heart rate. A suitable regimen for an adult is:

A severely symptomatic patient may require more frequent or higher doses.

If beta-blocker therapy is contraindicated in an adult, use:

For a child, a suitable beta-blocker regimen is:

Beta-blocker or diltiazem therapy is only necessary until the patient becomes euthyroid.