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Neurological Manifestations of Thyroid Disease Medication

  • Author: Gabriel Bucurescu, MD, MS; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
Updated: Dec 17, 2015

Medication Summary

The goal is to establish a euthyroid state. In hypothyroidism, this involves thyroid replacement, which is attained readily. In hyperthyroidism, elevated thyroid hormone is treated with surgery, which causes hypothyroidism and requires thyroid replacement, or with drugs and radioactive iodine.

Symptoms that are associated with abnormal thyroid states are treatable.


Thiourea derivatives

Class Summary

These medications are preferred for suppressing thyroid function.

Propylthiouracil (PTU)


Propylthiouracil is a derivative of thiourea that inhibits organification of iodine by the thyroid gland. It also inhibits the conversion of T4 to T3, which is advantage over other agents.

Methimazole (Tapazole)


Methimazole suppresses thyroid function and has a mechanism similar to that of PTU; it does not inhibit peripheral conversion of T4 to T3. Methimazole is fifteen times as potent as PTU. PTU-equivalent dosing can be used, divided thrice daily.


Beta-adrenergic blocking agents

Class Summary

These agents are used to treat symptomatic hyperthyroidism.

Propranolol (Inderal)


This nonselective, beta-adrenergic blocking agent treats symptomatic tachycardia. Propranolol has membrane-stabilizing activity and decreases the automaticity of contractions.


Thyroid hormones

Class Summary

These agents are used in thyroid hormone replacement.

Levothyroxine (Synthroid, Levoxyl)


Levothyroxine is synthetic, but it is identical to natural T4; in its active form, levothyroxine influences the growth and maturation of tissues; it is involved in normal growth, metabolism, and development.



Class Summary

These agents replace depleted electrolytes.

Potassium chloride (K-DUR)


Potassium chloride is essential for the transmission of nerve impulses, maintenance of intracellular tonicity, and maintenance of normal renal function. It is also vital for skeletal and smooth muscles. Potassium chloride replaces potassium lost in thyrotoxic periodic paralysis.



Class Summary

These agents provide immunosuppressive therapy for Graves ophthalmopathy, especially in cases of severe exophthalmos.

Prednisone (Deltasone, Sterapred, Orasone)


Prednisone is a widely used glucocorticoid that suppresses inflammatory processes by reversing increased capillary permeability and suppressing PMN activity; it is used to treat allergic, inflammatory, and autoimmune disorders.


Tricyclic antidepressants

Class Summary

These agents may help relieve painful polyneuropathy.

Amitriptyline (Elavil)


By inhibiting the reuptake of serotonin and/or norepinephrine by presynaptic neuronal membrane, amitriptyline may increase the synaptic concentration of these neurotransmitters in the CNS; it is useful as an analgesic for certain chronic and neuropathic pain.


Antiepileptic agents

Class Summary

These agents are useful in treating neuropathic pain.

Gabapentin (Neurontin)


Gabapentin's exact mechanism is unknown. It is structurally related to GABA and is useful in some pain syndromes.

Contributor Information and Disclosures

Gabriel Bucurescu, MD, MS Staff Neurologist, Neurology Service, Philadelphia Veterans Affairs Medical Center

Gabriel Bucurescu, MD, MS is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Nicholas Lorenzo, MD, MHA, CPE Founding Editor-in-Chief, eMedicine Neurology; Founder and CEO/CMO, PHLT Consultants; Chief Medical Officer, MeMD Inc

Nicholas Lorenzo, MD, MHA, CPE is a member of the following medical societies: Alpha Omega Alpha, American Association for Physician Leadership, American Academy of Neurology

Disclosure: Nothing to disclose.

Additional Contributors

Thomas A Kent, MD Professor and Director of Stroke Research and Education, Department of Neurology, Baylor College of Medicine; Chief of Neurology, Michael E DeBakey Veterans Affairs Medical Center

Thomas A Kent, MD is a member of the following medical societies: American Academy of Neurology, Royal Society of Medicine, Stroke Council of the American Heart Association, American Neurological Association, New York Academy of Sciences, Sigma Xi

Disclosure: Nothing to disclose.

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