Graves’ Disease: What Medications Are Available? (2023)

  • Overview
  • Antithyroid medications (thioamides)
  • Beta-blockers
  • Potassium iodide
  • Steroids for Graves’ dermopathy and Graves’ ophthalmopathy
  • Teprotumumab
  • The lowdown

Graves’ disease is a chronic autoimmune disorder that affects the thyroid, a small gland located at the base of your neck. The condition causes an overproduction of the two thyroid hormones, triiodothyronine (T3) and thyroxine (T4), which is known as hyperthyroidism.

Medications form an important part of the treatment of Graves’ disease. They work by preventing the excessive production of thyroid hormones, reducing symptoms associated with hyperthyroidism, and treating the secondary complications of the disease.

There are four types of medications that can treat Graves’ disease:

  1. Anti-thyroid medications

  2. Beta-blockers

  3. Potassium iodide

  4. Steroids

Not all of these medications might be suitable for you, and it is essential to consult with your doctor before taking something new.

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Antithyroid medications (thioamides)

There are a few types of antithyroid medications, including the following:

  • Methimazole (Tapazole)

  • Propylthiouracil (Propacil)

  • Carbimazole (Camazol), which is currently not approved for use in the United States

How are antithyroid medications used?

Antithyroid medications are typically taken for 12 to 18 months,¹ even if your hyperthyroidism symptoms subside during this time.

This length of treatment has been shown to offer the best chance of remission. Over time, your dosage can be reduced if you continue to show improvements.

The starting dosage of methimazole is usually between 10mg to 40mg,² and it is taken once per day. With propylthiouracil, the starting dosage is between 50mg to 150mg,² taken three times per day.

For carbimazole, the starting dose is 20mg to 60mg,³ taken once per day.

(Video) Graves Disease and Graves Ophthalmopathy | Signs, Symptoms, Diagnosis and Treatment

How do thioamides help with Graves’ disease?

Antithyroid medications stop the thyroid from producing hormones (T3 and T4). This is achieved by preventing the uptake of iodine, which helps the thyroid produce its hormones.

This action, in turn, reduces the symptoms of hyperthyroidism and restores normal thyroid function.

Thioamides can also be used as supplementary treatments in the following circumstances:

  • Before or after radioiodine therapy

  • Before thyroid surgery to restore normal thyroid function (euthyroidism) and minimize the risk of complications during surgery

  • Alongside other treatments such as beta-blockers

  • Propylthiouracil can inhibit the conversion of T4 to T3 (T3 is stronger and more biologically active than T4)

What are the benefits of antithyroid medications?

Studies show that after 12 to 18 months of using antithyroid medications, patients’ remission rates for Graves’ disease range from 30% to 70%.⁴

What are the risks and side effects?

Antithyroid medications are not a quick fix. It can take three to six weeks, and even up to three months⁵ in some cases before you notice a significant improvement in symptoms.

This is because antithyroid medications only block the formation of new thyroid hormones; they do not remove hormones that are stored or circulating through the bloodstream.

In addition, antithyroid medications are not a definitive cure for Graves’ disease. There is a chance that your hyperthyroidism associated with Graves’ disease will return.

Some of the side effects of thioamides include:

  • Allergic reactions, such as a rash

  • Gastrointestinal problems

  • A low white blood cell count (agranulocytosis)

  • Joint pain

  • Liver failure

A low white blood cell count increases your risk of infections. If you experience a sudden onset of sore throat, fever, or mouth ulcers, these could be signs of agranulocytosis, and you should seek urgent medical attention.

Women in their first trimester of pregnancy are also advised to use propylthiouracil, as methimazole has a high risk of congenital disabilities.

Propylthiouracil is the treatment of choice in pregnancy, as long as doses less than 300mg per day are used.

However, propylthiouracil does come with a risk of liver disease, so except for pregnant women, methimazole is usually the recommended medication for people with Graves’ disease.

While taking antithyroid medications, there is also a chance that you could develop hypothyroidism, a condition where the thyroid doesn’t produce enough thyroid hormones.

Not taking the medication correctly or stopping it altogether can cause thyroid storm (severe thyrotoxicosis), a sudden worsening of severe hyperthyroidism symptoms that can be fatal. Always consult your doctor before discontinuing your medications.

(Video) Graves' Disease: Everything You Need To Know


Beta-blockers are most commonly used to treat cardiovascular diseases such as high blood pressure. However, they can also be used for managing hyperthyroidism.

Examples of beta-blockers include atenolol (Tenormin), propranolol (Inderal), and metoprolol (Lopressor). Propranolol is the preferred option for managing hyperthyroidism.

How are beta-blockers used?

In Graves’ disease, beta-blockers are often used in the following conditions:

  • Control symptoms before radioiodine is administered

  • If antithyroid medications are unsuitable

  • Relieve symptoms while waiting for test results or for longer-term medications to begin working

With propranolol, you will start with a low dose of 20mg to 40mg,⁶ four times per day. This can go up to 240mg-480mg⁷ per day if there is no concern about your ability to clear it from your body safely.

The use of beta-blockers can be continued until your thyroid functions normally, that is, until your thyroid hormones are within a normal range.

How do beta-blockers help with Graves’ disease?

Beta-blockers reduce some of the symptoms associated with hyperthyroidism, such as rapid heart rate, heat intolerance, palpitations, muscle tremors, and anxiety. This is achieved by blocking the effects of a chemical messenger called adrenaline.

Beta-blockers can also inhibit the enzyme⁸ that converts T4 to T3.

Furthermore, these medications can help to prevent excess blood loss during surgery.

What are the benefits?

Beta-blockers work quickly, allowing for prompt control of symptoms.

Non-selective beta-blockers such as propranolol directly affect hypermetabolism, a defining feature of hyperthyroidism.

What are the risks and side effects?

Beta-blockers only treat symptoms, and they do not stop the thyroid from over-producing thyroid hormones or remove your thyroid antibodies. This means they don’t directly treat Graves’ disease.

Because of this, it is important to use beta-blockers in conjunction with other treatments such as antithyroid medications, surgery, or radioiodine therapy.

The side effects of beta-blockers include nausea, low heart rate, insomnia, anxiety, and low blood sugar levels. Additionally, beta-blockers can be dangerous in people with

  • Decompensated heart failure

  • A low heart rate

  • Spontaneous low blood sugar levels

  • Asthma⁷

Potassium iodide

Potassium iodide is a salt made of a stable form of iodine. It protects the thyroid gland from radioactive iodine and subsequent radiation damage.

How is potassium iodide used?

Potassium iodide comes in the form of tablets or oral solutions.

For oral solutions, you will need to add a few drops of potassium iodide into water or juice; this helps prevent gastrointestinal issues. These solutions can be taken three times daily, starting ten days before surgery, if used for this purpose.

The typical dosage is about 250mg per day. It should be noted that a safe and effective dosage has not yet been determined for children.

Benefits occur two to seven days after commencing treatment. Potassium iodide is usually only used for two weeks due to the risk of adverse effects if used long-term.

How does potassium iodide help with Graves’ disease?

After potassium iodide is rapidly absorbed, it can block radioactive iodine uptake into the thyroid gland (via the Wolff-Chaikoff effect).⁹

Studies have shown it to be effective for hyperthyroidism, and a potassium iodide preparation is recommended by the American Thyroid Association guidelines.

Potassium iodide has a few important uses in Graves’ disease. In the short term, it can be used in combination with antithyroid medications. It leads to a faster normalization⁸ of thyroid hormone levels, particularly in the first two weeks of treatment.

It is often used for a short period before surgery (thyroidectomy) to reduce the production and release of thyroid hormones. It will prevent blood loss in surgery by reducing the vascularity of the thyroid gland.

Potassium iodide is also used after radioiodine therapy. It may be used if beta-blockers fail to control hyperthyroidism.

What are the benefits?

In a study of people with Graves’ disease¹⁰ who experienced side effects from antithyroid medications, potassium iodide therapy was beneficial in two-thirds of cases, and 40% of users reached remission.

The usage of potassium iodide is also reversible,⁹ which helps limit severe side effects.

What are the risks and side effects?

Potential side effects of potassium iodide usage include swelling in the salivary glands, a metallic taste in the mouth, sore teeth and gums, diarrhea, and stomach pain.

Toxicity can cause iodide-induced hypothyroidism with prolonged use, but this is reversible with discontinuation.

Potassium iodide is not recommended for:

  • Pregnant or breastfeeding women, due to the risks to the fetus

  • Immunocompromised people

  • People with an allergy to iodine

  • People with chronic kidney failure

(Video) Understanding Hyperthyroidism and Graves Disease

Steroids for Graves’ dermopathy and Graves’ ophthalmopathy

Steroids containing hydrocortisone are beneficial when Graves’ disease affects the skin via a rare condition known as Graves’ dermopathy. Although mild cases can improve without treatment, moderate to severe cases can benefit from certain steroids.

Corticosteroids such as prednisone are the most common medication used for Graves’ ophthalmopathy, another condition associated with one-third of people who have Graves’ disease.

(Video) Hyperthyroidism vs. Hypothyroid RN LPN NCLEX

With Graves’ ophthalmopathy, the muscles and tissues behind the eyes are affected by the body’s autoimmune response and become inflamed, causing them to bulge outward.

How are they used?

For Graves’ dermopathy, steroids can take the form of a cream that is directly applied onto the skin or may be given as an intravenous (IV) injection. Their role is to reduce the inflammation that is causing negative skin effects.

For Graves’ ophthalmopathy, steroids can be taken orally. However, studies show that taking a higher dosage of steroids through an IV can be more effective and cause fewer side effects.

How do they help with Graves’ disease?

Steroids reduce the inflammation that is the underlying cause of the skin effects associated with Graves’ dermopathy. They also help reduce the immune response and the swelling behind the eyeballs in Graves’ ophthalmopathy.

What are the benefits?

A study showed that prednisone led to reduced retraction¹¹ of the upper eyelid and less prominent bulging after just one week.

After four weeks, there were no signs of inflammation in the anterior segment of the eye. After twelve weeks, there were further improvements.

What are the risks and side effects?

Possible side effects of steroids include fluid retention, weight gain, and high blood pressure.

Steroids are generally not a long-term option for treating Graves’ ophthalmopathy or Graves’ dermopathy. Extensive use can lead to weak and brittle bones (osteoporosis) and muscle weakness.


Teprotumumab (Tepezza) is a drug recently approved by the US Food and Drug Administration (FDA).¹¹

How does teprotumumab help with Graves’ disease?

Studies of teprotumumab have shown promising results, with 71% and 83%¹¹ of patients in two different studies experiencing at least a 2mm reduction in the bulging eyes (proptosis).

How is teprotumumab used?

Teprotumumab is usually given through an intravenous injection once every three weeks, for up to a total of eight times. The recommended dose¹² is an initial 10mg/kg, with subsequent treatments using 20mg/kg.

What are the benefits?

According to the FDA, teprotumumab provides an alternative, non-surgical option¹¹ that can alter the course of the disease and prevent patients from needing multiple invasive surgeries.

What are the risks and side effects?

Some of the possible side effects of teprotumumab include nausea, muscle spasms, diarrhea, high blood sugar, dry skin, an altered sense of taste, and hearing loss.

These symptoms are usually temporary¹³ and are believed to be less severe than the side effects of steroids or radiotherapy.

Pregnant women should not use teprotumumab due to risks to the fetus. If you are planning a pregnancy, it is advised to discontinue teprotumumab at least six months beforehand.

Teprotumumab may also worsen pre-existing inflammatory bowel disease.

The lowdown

Medications are an effective way to treat Graves’ disease, hyperthyroidism, and its associated symptoms.

However, there is no guarantee that any of these medications will cure hyperthyroidism, as even with anti-thyroid drugs, there is a risk of recurrence. In this case, other forms of treatment should be considered, such as surgery or radioiodine therapy.

(Video) What are the treatments for Graves’ disease?


What is the drug of choice for Graves disease? ›

These prescription medications include propylthiouracil and methimazole (Tapazole). Because the risk of liver disease is more common with propylthiouracil, methimazole is considered the first choice when doctors prescribe medication.

What is the most common treatment for Graves disease? ›

Radioiodine therapy is a common and effective treatment. You can take radioactive iodine-131 by mouth as a capsule or liquid. Radioiodine therapy slowly destroys the cells of the thyroid gland that produce thyroid hormone.

What is the drug of choice for the treatment of hyperthyroidism? ›

For this reason, methimazole is the first choice for treating hyperthyroidism. During treatment, your blood thyroid hormone levels will be monitored periodically. Antithyroid drugs typically reduce levels of both triiodothyronine (T3) and thyroxine (T4), but levels of T3 may take longer to return to normal.

Are there any new treatments for Graves disease? ›

The clinical demand for new therapeutic regimens of Graves' disease has led to the emergence of several new therapeutic ideas, including biologics, small molecule peptides, immunomodulators and teprotumumab.

What is the first line of treatment for Graves disease? ›

In the United States, radioactive iodine is the treatment of choice for most patients with Graves' disease and toxic nodular goiter. It is inexpensive, highly effective, easy to administer, and safe.

What is the alternative to methimazole? ›

One alternative to methimazole is propylthiouracil (PTU). Unlike methimazole, PTU is safe during the first trimester of pregnancy; however, it carries a risk for hepatotoxicity. A more aggressive treatment is radioactive iodine ablation of the thyroid gland.

Which treatment is better for Graves disease? ›

Radioactive iodine treatments and antithyroid drugs are usually effective in slowing down thyroid hormone output, but in some cases surgery is the best approach for Graves' disease.

What triggers Graves disease relapse? ›

Many risk factors are reportedly associated with a high GD recurrence rate, including age, sex, smoking status, pressure, goiter size, thyroid hypervascularization, disease severity, presence of Graves' orbitopathy (GO), thyrotropin receptor antibody (TRAb) level, family history, and genetic predisposition.

What should you not do if you have Graves disease? ›

In addition to managing stress, it is essential for people with Graves' disease to refrain from smoking. It not only increases the risk of Graves' disease but can also aggravate symptoms and increase the risk of an eye condition known as Graves' ophthalmopathy (also known as thyroid eye disease).

Can you take methimazole for life? ›

Long-term therapy with methimazole is not usually considered in treating patients with a toxic nodular goiter since this will never go into remission. However, methimazole has been shown to be safe for long term use in patients with Graves' disease.

What is the gold standard treatment for hyperthyroidism? ›

Radioactive iodine is the most widely-recommended permanent treatment of hyperthyroidism.

Do you always have Graves disease once you have it? ›

Graves' disease is a lifelong (chronic) condition. However, treatments can keep your thyroid hormone levels in check. Medical care may even make the disease temporarily go away (remission).

Can you live with Graves disease without treatment? ›

Graves' disease is rarely life-threatening. However, without treatment, it can lead to heart problems and weak and brittle bones. Graves' disease is known as an autoimmune disorder. That's because with the disease, your immune system attacks your thyroid — a small, butterfly-shaped gland at the base of your neck.

Can Graves disease be managed without medication? ›

Unlike some other conditions, Graves' disease can't be reversed with dietary changes alone. It has to be treated with conventional medication.

How does an endocrinologist treat Graves disease? ›

Your doctor may recommend prescription medications to help manage your symptoms and treat Graves' disease. This may include medications to regulate the amount of hormones your thyroid produces. Your doctor may recommend a radioactive iodine treatment to help shrink your thyroid gland.

What is the main cause of Graves disease? ›

Graves disease is the most common cause of hyperthyroidism. It is due to an abnormal immune system response that causes the thyroid gland to produce too much thyroid hormone. Graves disease is most common in women over age 20. But the disorder can occur at any age and can affect men as well.

What happens to your body when you stop taking methimazole? ›

Effects of Skipping Antithyroid Medication

If you skip or stop your medicine entirely, you can experience a number of short-term and long-term consequences, including: Debilitating weight loss. Dramatically increased appetite and thirst. Nervousness, anxiety, panic attacks.

Why is methimazole a hazardous drug? ›

Methimazole has been classified as hazardous because the medication impedes the body from using iodine to make thyroid hormone, thereby inhibiting synthesis of the hormone. The drug may cause birth defects and has been found to cause cancer in rodents.

How long can you take methimazole for Graves disease? ›

Conclusion: Administration of low-dose methimazole for a total of 60-120 months safely and effectively treats Graves' hyperthyroidism, with much higher remission rates than those attained by using conventional 18-24-month courses.

What can worsen Graves disease? ›

What to Limit When You Have Graves' Disease. Caffeine: Foods that contain caffeine—coffee, soda, tea, and chocolate—can aggravate Graves' disease symptoms, such as anxiety, nervousness, rapid heart rate, and weight loss.

What autoimmune goes with Graves disease? ›

Graves disease is associated with pernicious anemia, vitiligo, diabetes mellitus type 1, autoimmune adrenal insufficiency, systemic sclerosis, myasthenia gravis, Sjögren syndrome, rheumatoid arthritis, and systemic lupus erythematosus.

Does Graves disease affect the brain? ›

If not treated properly, Graves' disease can affect your brain, your heart, and your muscles. In more severe forms, it can cause painful muscle aches, sociopathic behavior, and even heart damage.

Can Graves disease go into permanent remission? ›

Can it cure Graves' disease? A third of patients remain in permanent remission. ¹ However, some of these patients still have TSH receptor antibodies, so some experts may not consider them fully cured.

What are the best vitamins to take for Graves disease? ›

According to research, vitamin D, selenium, L-carnitine, and vitamin B12 may help people with Graves' disease.

How do you slow down Graves disease? ›

Anti-thyroid medicine.

These medications slowly ease symptoms of hyperthyroidism by preventing the thyroid gland from making too many hormones. Anti-thyroid medications include methimazole and propylthiouracil. Symptoms usually begin to improve within several weeks to months.

What supplements should I avoid with Graves disease? ›

Any vitamins or supplements that contain iodine (especially kelp and dulse)
These include:
  • Olive oil.
  • Avocado oil.
  • Coconut oil.
  • Sunflower oil.
  • Safflower oil.
  • Avocado.
  • Flaxseed oil.
Apr 9, 2021

Is methimazole hard on liver? ›

Methimazole is also capable of causing clinically apparent, idiosyncratic liver injury. The onset of hepatotoxicity is usually within 2 to 12 weeks of starting and the pattern of enzyme elevations is typically cholestatic or mixed, although hepatocellular patterns have also been described.

How much weight do you gain on methimazole? ›

According to research, after starting Methimazole, the typical weight gain was approximately 12 pounds in 42 individuals with Graves' disease.

What are the long term side effects of methimazole? ›

Other side effects of Methimazole
  • Abnormal loss of hair.
  • changes in skin coloring.
  • difficulty in moving.
  • heartburn.
  • joint pain or swelling.
  • loss of taste.
  • muscle pain, cramps, or stiffness.
  • pain or discomfort in the chest, upper stomach, or throat.
Jan 5, 2023

Which drug is the first choice for thyroid crisis? ›

Treatment / Management

After initial supportive measures, a beta-blocker should be started for any case of suspected thyroid storm. Typically, propranolol 40 mg to 80 mg is given every 4 to 6 hours.

What is the safest treatment for hyperthyroidism? ›

Radioactive iodine treatment

It's a highly effective treatment that can cure an overactive thyroid. You're given a drink or capsule that contains iodine and a low dose of radiation, which is absorbed by your thyroid. Most people only need a single treatment.

What is the best thyroid supplement for hyperthyroidism? ›

A natural supplement that may help treat the effects of hyperthyroidism is L-carnitine. L-carnitine is an amino acid derivative that naturally occurs in the body. It's often found in weight loss supplements. It's also found in foods like meat, fish, and dairy products.

How long does it take for Graves disease to go into remission? ›

In approximately 40 to 50 percent of cases, anti-thyroid medication leads to remission of Graves' disease after the medication is taken daily for 12 to 18 months.

Is Graves disease a risk with Covid? ›

Conclusions. COVID-19 infection can cause Graves' disease and thyrotoxicosis. The onset of this disease after SARS-CoV-2 does not depend on the presence of pre-existing thyroid pathology and requires the appointment of glucocortisteroids.

Can you be misdiagnosed with Graves disease? ›

The symptoms of panic disorder and Graves' disease often overlap, which makes it difficult to distinguish between the two conditions. There is a high risk of misdiagnosis, especially on weekend or holiday shifts where medical resources are scarce and when fatigue and exhaustion set in.

Does Graves disease affect memory? ›

Cognitive Symptoms in Hyperthyroidism

Hyperthyroidism occurs when your thyroid gland produces more thyroid hormone than your body needs. Some people with hyperthyroidism, such as Graves' disease, commonly experience poor concentration, slower reaction times, decreased spatial organization, and memory lapses.

Can you cure Graves disease with diet? ›

Graves' disease is a leading cause of hyperthyroidism. While it cannot be cured through diet, its symptoms can be reduced or alleviated in some people. Learning if you have any food sensitivities or allergies will help you determine what you should and shouldn't eat.

What is the cure rate for Graves disease? ›

Remission rate after 10 years is in the order of 30% to 40%, and hypothyroidism has developed in 10% to 15% 15 years after ATD [59]. Taken into account the above reviewed literature, permanent cure of Graves' hyperthyroidism is possible albeit at a low rate of about 27% (Fig. 2).

Can Graves disease go away with medication? ›

Graves' disease is a lifelong (chronic) condition. However, treatments can keep your thyroid hormone levels in check. Medical care may even make the disease temporarily go away (remission).

How long do you take methimazole for Graves disease? ›

For methimazole

Adults and teenagers—At first, 15 to 60 milligrams (mg) a day for up to six to eight weeks. Later, your doctor may want to lower your dose to 5 to 30 mg a day. This may be taken once a day or it may be divided into two doses a day.

Can Graves disease be treated with medication? ›

If left untreated, patients may have multiple systemic complications such as cardiac, reproductive, and skeletal disease. Thionamides, such as methimazole and propylthiouracil, and I131 iodine ablation are the most commonly prescribed treatment for Graves' disease.

What causes Graves disease to flare up? ›

Emotional or physical stress. Stressful life events or illness may act as a trigger for the onset of Graves' disease among people who have genes that increase their risk. Pregnancy. Pregnancy or recent childbirth may increase the risk of the disorder, particularly among women who have genes that increase their risk.

What can you not do with Graves disease? ›

What to Limit When You Have Graves' Disease. Caffeine: Foods that contain caffeine—coffee, soda, tea, and chocolate—can aggravate Graves' disease symptoms, such as anxiety, nervousness, rapid heart rate, and weight loss.

Can I stay on methimazole forever? ›

Long-term therapy with methimazole is not usually considered in treating patients with a toxic nodular goiter since this will never go into remission. However, methimazole has been shown to be safe for long term use in patients with Graves' disease.

What happens when you go off methimazole? ›

Effects of Skipping Antithyroid Medication

If you skip or stop your medicine entirely, you can experience a number of short-term and long-term consequences, including: Debilitating weight loss. Dramatically increased appetite and thirst. Nervousness, anxiety, panic attacks.


1. Graves Disease - Overview (causes, pathophysiology, investigations and treatment)
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2. How To Cure Graves' Disease - Dr. Raymond Douglas
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3. Is Long-term Antithyroid Use the Best Treatment for Graves Disease?
4. 8 Things Your Doctor Won’t Tell You About Grave’s Disease
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5. Graves Disease Medications & Supplements - What Patients Need to Know
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6. Graves Disease – Endocrinology | Lecturio
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