Thyroid disease: Long-term management of hyperthyroidism and hypothyroidism

Hypothyroidism and hyperthyroidism are commonly encountered in clinical practice. General practitioners have a central role in the long-term management of these conditions.

The aim of this review is to provide an overview of the causes of thyroid function disorders and guidance on management.

Optimal management of hypothyroidism relies on an understanding of the potential risks and benefits of therapy versus observation. If levothyroxine (LT4) replacement is commenced in a person with subclinical hypothyroidism on the basis of the presence of possibly relevant hypothyroid symptoms, consideration should be given to ceasing LT4 if no symptomatic benefit is observed. Thyroid stimulating hormone levels below the reference range are associated with atrial fibrillation and osteoporosis, and should be avoided. Treatment modalities for hyperthyroidism include antithyroid medications, radioactive iodine therapy and thyroidectomy. Each is satisfactory, but none is ideal. A patient-centred choice of treatment modality should be individualised, taking into consideration the underlying pathology, age, sex, patient preference and availability of expert thyroid surgical care. Long-term management of patients with hyperthyroidism requires careful consideration of the likely outcomes of treatment including the risk of hypothyroidism.