Q:

When do we start antithyroid drugs for a patient with thyrotoxicosis?

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A 30-year-old woman presents with complaints of palpitations, tremulousness and weight loss of around 4 kg (despite a good appetite) over the last 2 months. On examination, she is anxious, has a pulse rate of 100/min, warm and moist peripheries, fine tremors of the outstretched hands and a visible goiter. No obvious abnormalities in the eyes. Her last menstrual period was 15 days ago. Her primary care physician orders for laboratory examination which reveals normal hemogram with an erythrocyte sedimentation rate of 25 mm in the first hour. Thyroid stimulating hormone (TSH) <0.001 mIU/L and total T4 28 mg/dL. A diagnosis of thyrotoxicosis is made. She is started on beta-blockers and she is asked to get a technetium uptake scan and review.

When do we start antithyroid drugs for a patient with thyrotoxicosis?

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Antithyroid drugs are used in patients of thyrotoxicosis secondary to hyperthyroidism. This class of drugs reduce the production of thyroid hormones by inhibiting iodine oxidation and organification of tyrosine residues in thyroglobulin. In India, methimazole, its precursor carbimazole and propylthiouracil are available. 10 mg of carbimazole is equivalent to 6 mg of methimazole. Carbimazole/methimazole is the preferred agent while propylthiouracil is reserved for special situations like first trimester of pregnancy or thyroid storm.

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