Toxic Nodular Goiter Medication

Updated: Oct 14, 2016
  • Author: Philip R Orlander, MD, FACP; Chief Editor: George T Griffing, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity, prevent complications, and provide a bridge to definitive therapy.

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Antithyroid agents

Class Summary

Inhibition thyroid hormone production. PTU and methimazole are thionamide derivatives. PTU is a thiourea antithyroid drug that blocks the production of thyroid hormones. A high doses, this drug also inhibits the peripheral deiodination of T4 to T3 and is used (1) in the management of hyperthyroidism, including treatment of Graves disease; (2) in the preparation of patients who are hyperthyroid for thyroidectomy; (3) as an adjunct to radioiodine therapy [24] ; and (4) as treatment for thyroid storm. Unlike PTU, methimazole lacks the ability to block peripheral conversion of T4 to T3.

Propylthiouracil

Thiourea agent that blocks the synthesis of thyroid hormones and inhibits peripheral deiodination of T4 to T3.

Methimazole (Tapazole)

Active moiety of parent compound carbimazole. A thiourea agent that blocks production of thyroid hormones.

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Radioactive iodines

Class Summary

Radioisotopes that decay by beta and gamma emissions are used to destroy autonomously functioning follicular cells of the thyroid gland.

Sodium iodide-131 (Na131 I; Iodotope)

Used to treat hyperthyroidism by destroying follicular cells of the thyroid gland. The dose is determined by radioactivity calibration system just prior to administration.

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Beta-adrenergic receptor antagonists

Class Summary

These inhibit chronotropic, inotropic, and vasodilatory responses to beta-adrenergic activity observed in hyperthyroidism.

Propranolol (Inderal)

Nonselective, competitive beta-receptor antagonist with no intrinsic sympathetic activity.

Propranolol treats cardiac arrhythmias resulting from hyperthyroidism, controls cardiac and psychomotor manifestations immediately, and blocks conversion of T4 to T3.

Atenolol (Tenormin)

Selectively blocks beta-1 receptors with little or no effect on beta-2 types. Atenolol treats cardiac arrhythmias resulting from hyperthyroidism and controls cardiac and psychomotor manifestations within min.

Metoprolol, metoprolol succinate, metoprolol tartrate (Lopressor, Toprol XL)

Selective beta-1 – adrenergic receptor blocker that decreases automaticity of contractions. Helps to treat cardiac arrhythmias resulting from hyperthyroidism. Controls cardiac and psychomotor manifestations within min.

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