Examining the therapeutic options in hyperthyroidism--a personal perspective

After confirmation of the diagnosis of hyperthyroidism, an aetiological clue should be ascertained. Any therapy should be directed toward the primary aetiology and should weigh the risk-benefit ratio carefully. Transient thyrotoxic states like thyroiditis may be treated with beta blockers, provided no contraindications exist. Beta blockers may also be used to treat the sympathetic symptoms and the response is usually rapid. The general trend is to use antithyroid drugs as first-line therapy, although relapses are the commonest problems with antithyroid drugs. Thionamides are the most common drugs used to treat the thyrotoxic state. Thionamides used in high doses have immunomodulatory effects and these effects can be utilised to reduce the risk of relapses in Graves' thyrotoxicosis. Iodides are usually reserved in the preoperative preparations of patients. Surgery, unlike medical therapy or radioiodine, can be offered as a therapeutic alternative only once. It may be offered where medical therapy has failed, where patients develop antithyroid drug allergies, and where the goitre causes obstructive symptoms or is of cosmetic concern. Prior to surgical therapy, adequate preparation should be obligatory. It is preferable to achieve clinical and biochemical euthyroidism prior to surgery. The use of radioiodine in therapeutics has become more acceptable and established. Although safe, it has the major drawback of cumulative hypothyroidism. There is still debate on the use of radioiodine in children. In 1989, the incidence of peritonitis was one episode every 24 patient-month which was significantly lower than the general population on CAPD of one episode every 17 patient-month.(ABSTRACT TRUNCATED AT 250 WORDS)