How do I manage my patients with thyrotoxicosis until they see the endocrinologist?

Article Figures & Data

TABLE 1

Recommended initial approach to thyrotoxicosis

Management area	Recommended plan
Diagnostic tests	Thyroid-stimulating hormone, free thyroxine (T4), free or total triiodothyronine (T3), thyroid-stimulating immunoglobulins, radioactive iodine uptake and scan
Symptomatic treatment of all patients (will not affect diagnostic tests)	Propranolol 10–40 mg 3 or 4 times daily or Atenolol 25–100 mg 1 or 2 times daily or Metoprolol tartrate 25–50 mg 2 or 3 times daily
Thyroid-directed treatment—if any 1 of elevated thyroid-stimulating immunoglobulins or high uptake of iodine 123 or high uptake of technetium 99m pertechnetate (will affect diagnostic tests) is found	Methimazole dosing based on free T4 levels: 1–1.5 × upper limit: 5–10 mg daily 1.5–2 × upper limit: 10–20 mg daily 2–3 × upper limit: 10–20 mg twice daily