Usually reserved for those who are unable to take antithyroid drugs. Symptomatic treatment only. Artificial tears or methyl cellulose drops for the discomfort, patching or prisms for diplopia, diuretics and raising the head of the bed for circumorbital edema. Toxic multinodular goiter is treated with 131 I or surgery. Antithyroid drugs will not induce permanent remission and should be used only as interim therapy.
Hypothyroidism is rare after therapy.
Autoimmune thyroiditis is transient and does not require definitive treatment except in those patients with recurrent hyperthyroidism. Propranolol may be used alone if symptoms are mild. Antithyroid drugs may be needed for a short time in some patients. In more severe cases, prednisone may be used at 40 mg PO QD, tapering to 10 mg each day over 2 weeks, and then continued for 1 month after patient becomes asymptomatic. Resolution of symptoms usually occurs in 1 to 6 months, and relapse is common.