gradual dose titration regime in thyrotoxicosis

Last edited 04/2018

Starting dose depends on the severity of the hyperthyroidism and the size of the thyroid gland

  • thiamazole
    • in mild hyperthyroidism and small glands - 10–15 mg daily
    • severe hyperthyroidism and large thyroids need 20–40 mg daily
  • carbimazole
    • equivalent dose is 140% of that of thiamazole.
  • propylthiouracil
    • usually 50–150 mg administered three times daily.

Thyroid function is measured every 4-6 weeks after initiation of therapy and dose is progressively lowered at regular intervals to allow endogenous synthesis of thyroid hormone to continue in a regulated fashion (1,2).

Once euthyroidism is achieved:

  • a maintenance dose of thiamazole of 5–10 mg daily, or 50 mg propylthiouracil two or three times daily, or lower
  • thyroid function is measured every 2-3 months
  • treatment shouldbe continued for 12-18 months (some suggest an even longer duration of therapy) (1)