Hyperthyroidism – Grade 2

Management escalation pathway

• Persue ICPI
• In the hyperthyroid phase, patients may benefit from beta blockers if symptomatic (e.g., atenolol 25–50 mg daily, titrate for HR < 90 if BP allows)
• Monitor closely with regular symptom evaluation and free T4 testing every 2 weeks
• Introduce thyroid hormones (see hypothyroidism management) if the patient becomes hypothyroid (low T4/T3, even if TSH is not elevated)
• Graves’ disease should be treated per standard guidelines.

Assessment and Investigations

FT3/FT4/TSH

Autoimmune serology:

• Anti-thyreoglobuline
• Anti-thyreoperoxidase
• TSI
• Imaging
• Thyroid echography (if nodules preset they should be further explored)
• Medication history: amiodarone or lithium therapy