Treatment of thyroiditis (Hashimoto's thyroiditis, subacute thyroiditis of de Quervain). Where hyperthyroidism is a feature, treatment is by a adrenoceptor blocking drug. Antithyroid drugs should not be used. Where there is permanent hypothyroidism, the treatment is thyroid hormone replacement.

Calcitonin: see Chapter 38.

Autoimmune disease of the thyroid can cause over- or underproduction of thyroid hormone.

• Hypothyroidism is readily treated by oral administration of levothyroxine 50 200 micrograms daily.This needs to be continued indefinitely.

• The treatment of hyperthyroidism due to Graves' disease is either I 2 months treatment with cafbimazole or propylthiouracil or a single diagnosis of '"'I.These drugs do not have a place in the 5 10% of patients in whom thyrotoxicosis is due to a toxic adenoma or to subacute thyroiditis.

• The natural history of Graves' disease is of alternating ¡"emission and relapse. Progression to hypothyroidism can occur, especially after fill treatment. Such patients should have long-term follow-up. and are likely to require thyroid hormone replacement therapy.

• Severe forms of thyroid eye disease should be treated with steroids and immunosuppresants or low-dose radiotherapy. Urgent surgical decompression can be required for exophthalmos.

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