Hyperthyroidism (Graves Disease): The Daily PANCE Blueprint
A 32-year-old woman reports palpitations, heat intolerance, unintentional weight loss, and tremor. Exam shows a diffuse goiter and exophthalmos. TSH is undetectable and free T4 is elevated. Which is the most appropriate first-line treatment?
A. Methimazole
B. Propylthiouracil
C. Levothyroxine
D. Radioactive iodine ablation
E. Total thyroidectomy
Answer and topic summary
The answer is A. Methimazole.
This is Graves disease — hyperthyroidism with a diffuse goiter and orbitopathy. Methimazole is the preferred first-line antithyroid drug: more potent, dosed once daily, and with fewer serious hepatic effects than propylthiouracil (PTU). PTU is reserved for the first trimester of pregnancy and for thyroid storm. Levothyroxine treats HYPOthyroidism. Radioactive iodine and surgery are definitive options, but RAI can worsen active Graves eye disease — so with her exophthalmos, an antithyroid drug is the better first move.
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