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Hyperthyroidism
Hyperthyroidism is a common disease affecting around 2 percent of women and 0.2 percent of men.20 Graves' disease is the most common cause of thyrotoxicosis, but other causes are toxic nodular goiter and toxic adenoma.21 Graves' disease is commonly treated with antithyroid drugs, radioactive iodine or thyroid surgery.22 Glucocorticoids may decrease the release of hormones and possibly protect against the adrenal insufficiency that may be associated with the hyperthyroid state. The amount of benefit and the effect on patient outcome in this circumstance is not yet known.23
Graves' eye disease is treated by first normalizing the thyroid function and then administering diuretics and systemic glucocorticoids.22 Some sources suggest that the treatment of Graves' disease with glucocorticoids may decrease the development of ophthalmopathy,24 while others do not recommend the use of corticosteroids in patients with mild to moderate ophthalmopathy before radioiodine treatment.21
Other causes of hyperthyroidism that may be treated with corticosteroids are subacute thyroiditis and thyroid storm. Hyperthyroid disease related to thyroiditis is usually mild and self-limited. Beta blockers may be used to treat symptoms. In subacute thyroiditis, nonsteroidal anti-inflammatory drugs or corticosteroids can be used to relieve thyroid pain and tenderness.25
Thyroid storm is a life-threatening condition of the hyperthyroid state.26 It most commonly occurs in patients with Graves' disease but may also occur in those with multinodular goiter or toxic adenoma.27 It is treated by correcting the hyperthyroidism and treating the precipitating events.26 Correction of the hyperthyroid state involves using drugs such as propylthiouracil or methimazole (Tapazole), beta blockers or corticosteroids, which decrease the peripheral effects of thyroid hormone and the conversion of thyroxine (T4) to the more potent triiodothyronine (T3).22,26 Dexamethasone can be used for that purpose, at a dosage of 2 mg intravenously every six hours, and can eventually can be switched to an oral dosage of 2 mg every six hours.28
A different look at corticosteroids.
Zoorob RJ, Cender D.
Am Fam Physician. 1998 Aug;58(2):443-50.
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