Dawaa Reference

chronic

Hyperthyroidism (Thyrotoxicosis)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

ATA Guidelines for Diagnosis and Management of Hyperthyroidism 2016 · Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph) · Egyptian National Drug Formulary - Endocrine System 2024 (propylthiouracil monograph) · Hyperthyroidism - disease-level clinical article (hyperthyroidism-clinical.txt) · Egyptian National Drug Formulary - Cardiovascular 2024 (verapamil monograph)

Verified against4 documents
  • Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph)
  • Egyptian National Drug Formulary - Endocrine System 2024 (propylthiouracil monograph)
  • Hyperthyroidism - disease-level clinical article (hyperthyroidism-clinical.txt)
  • Egyptian National Drug Formulary - Cardiovascular 2024 (verapamil monograph)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Common complaints include unintended weight loss, though about 10% of patients gain weight instead due to increased appetite [weight loss]
  • Patients often report palpitations, tremor, heat intolerance, breathlessness on exertion, anxiety, irritability, fatigue, and muscle weakness [anxiety · breathlessness · fatigue · heat intolerance · irritability · muscle weakness · palpitations · tremor]
  • Bowel movements become more frequent, and some patients develop significant diarrhea [diarrhoea]
  • Hair loss, reduced libido, and irregular or absent periods in women can also occur [absent periods · hair loss]
  • Subacute thyroiditis classically presents with marked anterior neck pain and fever [fever · neck pain]

Signs — what you find (5)

  • Exam often shows a fast pulse (sometimes atrial fibrillation), high blood pressure, tremor, warm moist skin, brisk reflexes, and an anxious appearance [anxiety · hyperreflexia · hypertension · tremor]
  • Lid lag or lid retraction is seen with any cause of overactive thyroid because it reflects a hyperadrenergic state, not Graves disease specifically
  • True eye involvement - double vision, excess tearing, conjunctival redness, and eye bulging - only occurs with Graves disease [double vision · eye discharge · eye redness]
  • Graves disease can also produce thick, scaly skin plaques on the shins and soft-tissue swelling with clubbing of the fingers [finger clubbing · plaques · scaling]
  • On palpation, the thyroid is diffusely and evenly enlarged in Graves disease, unevenly nodular in toxic multinodular goiter, shows one large lump in a toxic adenoma, and is exquisitely tender in subacute thyroiditis [goitre]

Tests (9)

  • Suspected disease is confirmed with TSH, free T4, and total T3; overt disease shows a suppressed TSH with high T4 and T3
  • Subclinical disease has a low TSH with normal T4 and T3, while T3 toxicosis has a low TSH, a normal T4, but a raised T3
  • Heterophile antibodies can falsely raise the TSH result, and high-dose biotin (5 to 30 mg) can falsely lower TSH while raising free T4
  • Checking TSH-receptor antibody first speeds up finding the cause and is more cost-effective than other work-up
  • When TSH-receptor antibody is normal, a radioiodine uptake scan is the next diagnostic step
  • Radioiodine scanning is avoided in pregnancy and breastfeeding
  • A toxic adenoma shows one hot spot of uptake matching the nodule, with the rest of the gland suppressed
  • Any thyroiditis shows low or absent uptake because inflamed follicular cells cannot take up iodine
  • Doppler ultrasound shows increased or normal blood flow in Graves disease (thyroid inferno) but low flow in thyroiditis

If not this — what else fits (4)

  • A non-tender, diffusely enlarged thyroid points to Graves disease or painless thyroiditis, or, rarely, to deliberately taken thyroid hormone
  • A tender, enlarged thyroid suggests De Quervain (subacute) thyroiditis instead
  • One palpable nodule points to a thyroid adenoma, while multiple nodules point to toxic multinodular goiter
  • Euthyroid hyperthyroxinemia - high total T4 and T3 with a normal TSH - and struma ovarii are other differentials to consider

SourceStatPearls "Hyperthyroidism" - disease-level clinical article

Presentation findings are traced to the source above.

1

CARBIMAZOLE

1st line

Strength5 mg

Formoral.solid

Adult dose and duration

Initial 20 to 60 mg/day given in 2 to 3 divided doses until euthyroid (4 to 8 weeks), then maintenance 5 to 15 mg once daily x 12-18 months course

Paediatric dose

(Children ≥3 years and Adolescents: Initial: 15 mg/day; adjust dose according to response.)

Dose by age
3 years and over:Initial 15 mg daily; adjust dose according to response
Dose source

Egyptian National Drug Formulary - Endocrine System 2024

Why

Thionamide antithyroid drug that blocks thyroid peroxidase to reduce new thyroid hormone synthesis; first-line for hyperthyroidism outside the first trimester of pregnancy, where propylthiouracil is preferred instead.

Cautions
  • WARN PATIENTS to report sore throat, fever, or mouth ulcers immediately (risk of agranulocytosis).
  • Perform baseline full blood count before starting treatment.
  • Avoid in 1st trimester of pregnancy (propylthiouracil preferred).
Egyptian brands
Egyptian brandManufacturerIndicative price
THYROCARBIN 5 MG 100 F.C. TABS.ROYAL LINK PHARMA107.00 EGP (1.07/unit)
THYROCARBIN 5 MG 50 F.C. TABS.ROYAL LINK PHARMA55.00 EGP (1.10/unit)
CARBIMAZOLE B.P 2007 5 MG 50 F.C. TABS.CID60.00 EGP (1.20/unit)
NEOMERCAZOLE(CARBIMAZOLE) 5 MG 100 TABS. (ILLEGAL IMPORT)AMIDPHARM40.00 EGP (0.40/unit)
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Hyperthyroidism - disease-level clinical article (hyperthyroidism-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Thyroid storm - a life-threatening complication of untreated/undertreated hyperthyroidism with a mortality rate around 16% in patients over 60 - requires immediate recognition and urgent (emergency/ICU-level) management.
3

PROPYLTHIOURACIL

2nd line

Strength50 mg

Formoral.solid

Adult dose and duration

300-400 mg daily in 3-4 divided doses until euthyroid, then titrate to maintenance 50-150 mg daily

Paediatric dose

(Children 6 to 10 years: initial 50 to 150 mg/day divided every 8 hours. Age ≥10 years: 150 to 300 mg/day divided every 8 hours. Maintenance: 50 mg twice daily.)

Dose by age
6 to 10 years:50 to 150 mg daily, divided every 8 hours
10 years and over:150 to 300 mg daily, divided every 8 hours. Maintenance 50 mg twice daily.
Dose source

Egyptian National Drug Formulary - Endocrine System 2024 (propylthiouracil monograph)

Why

Thionamide antithyroid drug that blocks thyroid peroxidase like carbimazole but also reduces peripheral conversion of T4 to T3; preferred over carbimazole specifically in the first trimester of pregnancy despite its own risk of hepatotoxicity.

Cautions
  • Propylthiouracil is the preferred antithyroid agent in the 1st trimester of pregnancy.
  • There is a black box warning for severe, life-threatening hepatotoxicity; monitor LFTs.
  • Report sore throat/fever immediately (agranulocytosis risk).
Egyptian brands
Egyptian brandManufacturerIndicative price
PROPYLTHIOURACIL 50MG 20 TAB. B.P 2002MEMPHIS14.00 EGP (0.70/unit)
THYROCIL 50 MG 30 TABS.AMOUN72.00 EGP (2.40/unit)
4

PROPRANOLOL

add-on - not a substitute

Strength10 mg

Formoral.solid

Adult dose and duration

10-40 mg three to four times daily PRN for rapid control of adrenergic symptoms (tachycardia, tremor, anxiety)

Paediatric dose

0.25-0.5 mg/kg/dose [child max 40 mg]

(0.25-0.5 mg/kg per dose, 3-4 times daily, under specialist guidance. The formulary ceiling is 1 mg/kg per dose four times a day; the 40 mg cap here is the adult per-dose maximum and binds first above 40 kg.)

Dose by weight
3kg0.75-1.5 mg/dose
4kg1-2 mg/dose
5kg1.2-2.5 mg/dose
6kg1.5-3 mg/dose
7kg1.8-3.5 mg/dose
8kg2-4 mg/dose
9kg2.2-4.5 mg/dose
10kg2.5-5 mg/dose
11kg2.8-5.5 mg/dose
12kg3-6 mg/dose
13kg3.2-6.5 mg/dose
14kg3.5-7 mg/dose
15kg3.8-7.5 mg/dose
16kg4-8 mg/dose
17kg4.2-8.5 mg/dose
18kg4.5-9 mg/dose
19kg4.8-9.5 mg/dose
20kg5-10 mg/dose
21kg5.2-10.5 mg/dose
22kg5.5-11 mg/dose
23kg5.8-11.5 mg/dose
24kg6-12 mg/dose
25kg6.2-12.5 mg/dose
26kg6.5-13 mg/dose
27kg6.8-13.5 mg/dose
28kg7-14 mg/dose
29kg7.2-14.5 mg/dose
30kg7.5-15 mg/dose
31kg7.8-15.5 mg/dose
32kg8-16 mg/dose
33kg8.2-16.5 mg/dose
34kg8.5-17 mg/dose
35kg8.8-17.5 mg/dose
36kg9-18 mg/dose
37kg9.2-18.5 mg/dose
38kg9.5-19 mg/dose
39kg9.8-19.5 mg/dose
40kg10-20 mg/dose
41kg10.2-20.5 mg/dose
42kg10.5-21 mg/dose
43kg10.8-21.5 mg/dose
44kg11-22 mg/dose
45kg11.2-22.5 mg/dose
46kg11.5-23 mg/dose
47kg11.8-23.5 mg/dose
48kg12-24 mg/dose
49kg12.2-24.5 mg/dose
50kg12.5-25 mg/dose
Dose source

Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph)

Why

Non-selective beta-blocker added for rapid symptomatic control of the adrenergic features of thyrotoxicosis such as tachycardia and tremor; it does not affect thyroid hormone synthesis and does not replace the antithyroid drug.

Cautions
  • Contraindicated in asthma and severe bronchospasm.
  • This is symptomatic management only; it does not affect underlying thyroid hormone synthesis.
  • Thyroid disease: May mask signs of hyperthyroidism (e.g., tachycardia). Monitor; gradual withdrawal when needed.
Egyptian brands
Egyptian brandManufacturerIndicative price
INDOLOL 10 MG 50 TABKAHIRA12.50 EGP (0.25/unit)
PROLOL 10 MG 50 TABS.EIPICO16.25 EGP (0.33/unit)
INDERAL 10 MG 50 TABSASTRA ZENECA75.00 EGP (1.50/unit)
5

VERAPAMIL

add-on - not a substitute

Strength40 mg

Formoral.solid

Adult dose and duration

Immediate release: 40 mg 3 to 4 times daily, increased as needed for rate control (maximum 480 mg/day in 1 to 3 divided doses) - until euthyroid

Paediatric dose

The ENDF verapamil monograph gives no paediatric rate-control figure, so none is stated here.

Dose source

Egyptian National Drug Formulary - Cardiovascular 2024 (verapamil monograph)

Why

Rate control for the patient who cannot take a beta-blocker; the card offered propranolol alone.

Cautions
  • Do not use in patients with pre-excitation associated with an accessory pathway, to avoid ventricular arrhythmias.
  • Contraindicated in AV block, cardiogenic shock, and acute porphyrias.
  • Contraindicated in atrial flutter or fibrillation associated with accessory conducting pathways, e.g. Wolff-Parkinson-White syndrome.
  • 'Until euthyroid' is the clinical framing of the disease article, not a duration stated by the ENDF
Egyptian brands
Egyptian brandManufacturerIndicative price
VERPAMIL 40MG 20 F.C.TAB.EL NASR4.50 EGP (0.23/unit)
VERATENS 40MG 10 F.C. TAB.PHAROPHARMA3.50 EGP (0.35/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.