Follow-up for hyperthyroidism

Follow-up and monitoring of hyperthyroidism

Monitoring after radioactive iodine treatment

• consider measuring TSH, FT4 and FT3 levels in adults, children and young people every 6 weeks for the first 6 months after radioactive iodine treatment until TSH is within the reference range.
• for adults, children and young people who have hypothyroidism after radioactive iodine treatment and are not on anti-thyroid drugs, offer levothyroxine replacement therapy and with dosage and monitoring as per management of primary hypothyroidism
• for adults, children and young people with TSH in the reference range 6 months after radioactive iodine treatment, consider measuring TSH (with cascading) at 9 months and 12 months after treatment.
• for adults, children and young people with TSH in the reference range 12 months after radioactive iodine treatment, consider measuring TSH (with cascading) every 6 months unless they develop hypothyroidism (then follow advice above)

If hyperthyroidism persists after radioactive iodine treatment in adults, children and young people, consider anti-thyroid drugs until the 6-month appointment.

If hyperthyroidism persists 6 months after radioactive iodine treatment in adults, children and young people, consider further treatment

Monitoring after surgery

Offer levothyroxine to adults, children and young people after a total thyroidectomy with dosage and monitoring as per management of primary hypothyroidism

Consider measuring TSH and FT4 at 2 and 6 months after surgery, and then TSH (with cascading) once a year for adults, children and young people who have had a hemithyroidectomy

Monitoring of anti-thyroid drugs

For adults, children and young people who are taking anti-thyroid drugs for hyperthyroidism, consider measuring:

• TSH, FT4 and FT3 every 6 weeks until their TSH is within the reference range,
• then TSH (with cascading) every 3 months until anti-thyroid drugs are stopped.

Do not monitor full blood count and liver function for adults, children and young people taking anti-thyroid drugs for hyperthyroidism unless there is a clinical suspicion of agranulocytosis or liver dysfunction.

For adults who have stopped anti-thyroid drugs, consider measuring:

• TSH (with cascading) within 8 weeks of stopping the drug,
• then TSH (with cascading) every 3 months for a year,
• then TSH (with cascading) once a year

For children and young people who have stopped anti-thyroid drugs, consider measuring:

• TSH, FT4 and FT3 within 8 weeks of stopping the drug,
• then TSH, FT4 and FT3 every 3 months for the first year,
• then TSH (with cascading) every 6 months for the second year,
• then TSH (with cascading) once a year

Reference:

1. Thyroid disease: assessment and management. NICE guideline NG145. Published: 20 November 2019 Last updated: 12 October 2023