Treatment of hyperthyroidism is directed at reducing the excessive synthesis and secretion of thyroid hormones. This may be accomplished by inhibiting thy-roidal synthesis and secretion with antithyroid drugs, by reducing the amount of functional thyroid tissue, or by both. Unfortunately, only a small proportion of patients treated with antithyroid drugs obtain long-term remission of their hyperthyroidism. Ablative therapy is often necessary. Since many of the signs and symptoms of hy-perthyroidism reflect increased cellular sensitivity to adrenergic stimulation, a p-adrenergic antagonist is often used adjunctively. Propranolol (Inderal), the most widely used p-adrenoceptor blocker, is effective in ameliorating many of the manifestations of thyrotoxicosis. It may reduce thyrotoxicosis-induced tachycardia, palpitations, tremor, sweating, heat intolerance, and anxiety, which are largely mediated through the adrenergic nervous system. Propranolol may also impair the conversion of T4 to T3. The use of propranolol is contraindi-cated in thyrotoxic patients with asthma or chronic obstructive pulmonary disease because it impairs bron-chodilation. It is also contraindicated in patients with heart block and those with congestive heart failure, unless severe tachycardia is a contributory factor.
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