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References

DOI: 10.1016/j.ecl.2021.12.004.

• Methimazole (MMI) should be used in patients who choose ATD therapy for GD, except (a) during the first trimester of pregnancy when propylthiouracil (PTU) is preferred, (b) in the management of thyroid storm, and (c) in patients with minor adverse reactions to MMI who refuse radioactive iodine (RAI) therapy or surgery.
• Current practice guidelines suggest an initial MMI dosing of 5–10 mg daily if free T4 is 1–1.5 times the upper limit of normal; 10–20 mg daily if free T4 is 1.5–2 times the upper limit of normal; and 30–40 mg daily for free T4 2–3 times the upper limit of normal.
• MMI can be given once-a-day compared to PTU which has a shorter duration of action and is usually administered as 50–150 mg 3 times daily.
• Once the patient is biochemically euthyroid, gradual lowering of the MMI dose is advised, with repeated laboratory testing in 4–6 weeks.
• Serum TSH, free T4 and total or free T3 should be obtained initially at 2–4 week intervals after starting ATDs, and the dosage should be adjusted accordingly.