1. MANAGEMENT

2. Goal: restoration of clinical and biochemical euthyroid state by omitting or reducing the dosage of medications and other measures as needed depending on clinical status. ECG Blood test: TSH, T3, T4 levels, monitored regularly SYMPTOMATIC TREATMENT: To control tachycardia, hypertension and atrial fibrillation: 20 - 40 mg doses of propranolo Q 6hours; d If beta blockers are contraindicated: Diazepam and/or chlorpromazine

3. RADIOACTIVE IODINE – ingestion of a radioactive iodine tablet (6-12 wks) which is then taken up by thyroid cells. These overactive cells are destroyed so that the thyroid can shrink in size and produce hormone at normal levels. – In patients with underlying heart disease and in elderly patients, it is desirable to treat with antithyroid drugs (methimazole) until the patient is euthyroid. The medication is then stopped for 5-7days before the appropriate dosage of 131 I. – Although it is a safe treatment, most people become hypothyroid after radioactive iodine therapy and therefore require lifelong thyroid hormone replacement therapy.

4. THYROIDECTOMY – Now uncommonly performed; the surgeon removes most or all of the gland – Candidates for surgery: include pregnant hyperthyroid patients intolerant of anti-thyroid drugs, patients desiring definitive therapy without the use of radioactive iodine, children, and patients with very large or multinodular goiters. – Patients are treated with antithyroid drugs until euthyroid (about 6wks). In addition, 10-14 days prior to surgery, they receive saturated solution of potassium iodide 5 drops BID, to diminish vascularity of the gland and simplify surgery – However, in cases of total removal of the thyroid gland, patient must take thyroid replacement pills for the rest of his or her life

5. NON-PHARMACOLOGICAL High calorie diet in order to replace all the energy burned by the body in hyperthyroid state Drink plenty of water and juices to replace all the fluid losses. Avoid or limit caffeinated drinks for such could produce anxiety.