Guidelines 4

• Younger patients with small goitres and mild case—18-month course antithyroid drugs.

• Older patients with small goitres—as above or radioiodine (when euthyroid).

• Large goitres or moderate to severe cases— antithyroid drugs until euthyroid, then surgery.

• In Australia (as in the USA) I131 is being increasingly used.

Treatment of autonomous functioning nodules

Control hyperthyroidism with antithyroid drugs, then surgery or I131. Long-term remissions on antithyroid drugs in a toxic nodular goitre are rare.

Treatment of subacute thyroiditis 6

Hyperthyroidism is usually transient and follows a surge of thyroxine after a viral-type illness. Symptoms include pain and/or tenderness over the goitre (especially on swallowing) and fever. In the acute phase treatment is based on rest, analgesics (aspirin 600 mg (o) 4-6 hourly) and soft foods. Rarely, when pain is severe, corticosteroids may be used. Antithyroid drugs are not indicated but beta-blockers can be used to control symptoms.

Thyroid crisis

Clinical features are marked anxiety, weakness, hyperpyrexia, tachycardia (> 150 per minute), heart failure and arrhythmias. It is usually precipitated by surgery or an infection in an undiagnosed patient. It requires urgent intensive hospital management with antithyroid drugs; IV saline infusion, IV corticosteroids, anti-heart failure and antiarrhythmia therapy.

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