"
Medical and Preoperative Management of Hyperthyroidism
Hyperthyroidism is characterized by an overproduction of thyroid hormones. It requires careful management through pharmacological and surgical interventions.
Medical Management of Hyperthyroidism
1. Antithyroid Drugs
- Methimazole: Inhibits thyroid hormone synthesis. Dose starts at 15-30 mg daily, tapered to 5-10 mg for maintenance.
- Propylthiouracil (PTU): Alternative for pregnant women in the first trimester. Dose: 300-600 mg daily, reduced to 50-300 mg for maintenance.
- Side effects: Agranulocytosis, rash, liver toxicity.
2. Beta-Blockers
- Propranolol: Controls symptoms like tachycardia and tremors. Reduces peripheral T4 to T3 conversion. Dose: 20-40 mg 2-3 times daily.
3. Radioactive Iodine (RAI)
- RAI Therapy: Destroys overactive thyroid tissue. Single oral dose of 10-15 mCi for most adults.
- Side effects: Potential hypothyroidism, thyroiditis.
4. Surgical Treatment
- Thyroidectomy: Considered when other treatments are ineffective or contraindicated.
- Preoperative management: Use of antithyroid drugs and beta-blockers before surgery.
Preoperative Management of Hyperthyroidism
1. Antithyroid Medications
- Ensure the patient is euthyroid before surgery using methimazole or PTU.
- If severe thyrotoxicosis, administer Lugol’s iodine to reduce thyroid vascularity.
2. Beta-Blockers
- Administer propranolol to manage symptoms of hyperthyroidism.
3. Correction of Electrolyte Imbalances
- Correct hypokalemia and dehydration before surgery.
4. Preparing for Thyroid Storm
- Ensure that protocols for managing thyroid storm are in place.
5. Patient Education
- Inform the patient about the risks of surgery and the need for lifelong thyroid hormone replacement.
