Hyperthyroidism
To be initiated on specialist advice. 15-40mg daily until euthyroid (usually 4-8 weeks), then progressively reduced to a maintenance dose, typically 5-15mg, daily usually for 18 months.
To be initiated on specialist advice. 15-40mg daily until euthyroid (usually 4-8 weeks), then progressively reduced to a maintenance dose, typically 5-15mg, daily usually for 18 months.
To be initiated on specialist advice. 15-40mg daily until euthyroid (usually 4-8 weeks), then progressively reduced to a maintenance dose, typically 5-15mg, daily usually for 18 months.
To be initiated on specialist advice. 15-40mg daily until euthyroid (usually 4-8 weeks), then progressively reduced to a maintenance dose, typically 5-15mg, daily usually for 18 months.
Propylthiouracil may be an alternative in early pregnancy or for patients who suffer sensitivity reactions to carbimazole.
To be initiated on specialist advice. 200-400mg daily, maintained until patient is euthyroid, and the dose can be gradually reduced to a maintenance dose of 50-150mg daily.
Prescribing Notes:
- Carbimazole 40-60mg daily may be given with levothyroxine 100-125micrograms daily in a block and replace regimen, usually for 18 months.
- Carbimazole has rarely been associated with bone marrow suppression and treatment should be stopped promptly if there is clinical or laboratory evidence of neutropenia. Patients should be asked to report symptoms and signs suggestive of infection, especially sore throat, fever or mouth ulcers. A white blood cell count should be performed if there is any clinical evidence of infection. If there is clinical or laboratory evidence of neutropenia, carbimazole or propylthiouracil should be stopped.
- Pregnant patients receiving anti-thyroid drugs must be monitored in secondary care.
- MHRA/ CHM (Feb 19) “Carbimazole is associated with an increased risk of congenital malformations when used during pregnancy, especially in the first trimester and at high doses (daily dose of 15 mg or more). Women of childbearing potential should use effective contraception during treatment with carbimazole. It should only be considered in pregnancy after a thorough benefit-risk assessment, and at the lowest effective dose without additional administration of thyroid hormones—close maternal, fetal, and neonatal monitoring is recommended.”
History Notes
16/02/2022
East Region Formulary content agreed.
Thyrotoxicosis (adjunct), 10-40mg 3-4 times daily.
Thyrotoxicosis (adjunct), 10-40mg 3-4 times daily.
Prescribing Notes:
- Propranolol can be withdrawn once hyperthyroidism is controlled (2-6 weeks), and the patient maintained on carbimazole.
History Notes
16/02/2022
East Region Formulary content agreed.
As per specialist.
History Notes
16/02/2022
East Region Formulary content agreed.
For dose, refer to BNF for Children and follow specialist advice.
For dose, refer to BNF for Children and follow specialist advice.
For dose, refer to BNF for Children and follow specialist advice.
For dose, refer to BNF for Children and follow specialist advice.
Propylthiouracil may be an alternative in early pregnancy or for patients who suffer sensitivity reactions to carbimazole.
For dose, refer to BNF for Children and follow specialist advice.
Prescribing Notes:
- Carbimazole may be given with levothyroxine in a block and replace regimen, usually for 18 months.
- See the link for the medicines for children leaflet: carbimazole for hyperthyroidism.
- Carbimazole and propylthiouracil have been associated with bone marrow suppression and treatment should be stopped promptly if there is clinical or laboratory evidence of neutropenia. Patients/carers should be asked to report symptoms and signs suggestive of infection, especially sore throat, fever or mouth ulcers. A white blood cell count should be performed if there is any clinical evidence of infection. If there is clinical or laboratory evidence of neutropenia, carbimazole or propylthiouracil should be stopped.
- Pregnant patients receiving anti-thyroid drugs must be monitored in secondary care.
- MHRA Drug Safety Update (Feb 19) “Carbimazole is associated with an increased risk of congenital malformations when used during pregnancy, especially in the first trimester and at high doses (daily dose of 15mg or more). Women of childbearing potential should use effective contraception during treatment with carbimazole. It should only be considered in pregnancy after a thorough benefit-risk assessment, and at the lowest effective dose without additional administration of thyroid hormones – close maternal, fetal and neonatal monitoring is recommended.”
- Refer to guidance in Scottish Paediatric Endocrine Group and British Society for Paediatric Endocrinology and Diabetes.
History Notes
29/02/2024
East Region Formulary content agreed.
Consider starting treatment at lower doses and increasing gradually, for example starting propranolol 10mg twice daily.
Prescribers should be aware of recent increases in propranolol overdoses and consider patients risk factors before prescribing.
For dose, refer to BNF for Children and follow specialist advice.
For dose, refer to BNF for Children and follow specialist advice.
For dose, refer to BNF for Children and follow specialist advice.
Prescribing Notes:
- Beta blockade can be withdrawn once hyperthyroidism is controlled (2-6 weeks), and the patient maintained on carbimazole.
- Beta-blockers are contra-indicated in asthma.
- Refer to guidance in Scottish Paediatric Endocrine Group and British Society for Paediatric Endocrinology and Diabetes.
History Notes
29/02/2024
East Region Formulary content agreed.
As per specialist.
Prescribing Notes:
- Refer to guidance in Scottish Paediatric Endocrine Group and British Society for Paediatric Endocrinology and Diabetes.
History Notes
29/02/2024
East Region Formulary content agreed.