How should I manage a patient with hyperthyroidism who is experiencing significant symptoms but has contraindications to antithyroid medications?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

In cases where a patient with hyperthyroidism has significant symptoms but contraindications to antithyroid medications, consider **supportive treatment with beta-blockers** to manage adrenergic symptoms, especially in the early stages before definitive treatment .

**Arrange urgent specialist assessment** to evaluate other definitive treatment options such as radioactive iodine or surgery, particularly if symptoms are severe or if there are concerns about the underlying cause .

**Discuss with the patient** the possible benefits and risks of all treatment options, including radioactive iodine and surgery, and involve them in shared decision-making .

If antithyroid drugs are contraindicated, **radioactive iodine treatment** is a first-line definitive treatment for adults with Graves' disease unless contraindicated (e.g., active orbitopathy, pregnancy, or breastfeeding) .

**Thyroid surgery** may be considered, especially if there are large goitres, suspicion of malignancy, or intolerance to medical therapy, and should be performed by a high-volume thyroid surgeon .

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