Hyperthyroidism Treatment Choice (Graves) — free guideline decision tool

This tool gives the preferred treatment modality for Graves hyperthyroidism — antithyroid drugs, radioiodine, or surgery — based on pregnancy, goiter size/severity, malignancy, ATD failure, eye disease, and age.

Branch logic by patient features → ATD (MMI preferred; PTU in first trimester/storm/severe), surgery (large goiter, malignancy, hyperparathyroidism), or ¹³¹I (ATD failure/relapse; cautious in active orbitopathy and contraindicated in pregnancy).

Use to direct modality choice: ATD for pregnancy/children/mild disease, surgery for large/compressive goiter or malignancy, and radioiodine or surgery for ATD failure (with eye-disease cautions for radioiodine).

Radioiodine is contraindicated in pregnancy/lactation and can worsen moderate-severe active Graves orbitopathy, favoring surgery or ¹³¹I with glucocorticoid cover. (original synthesis · not guideline verbatim) During ATD, monitor liver function and white-cell count for agranulocytosis; β-blockers give symptomatic relief. All three modalities have trade-offs in cure rate, relapse, and resulting hypothyroidism, so choice is individualized with patient preference.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: Pregnancy Yes, Severity/goiter Milder, mild-moderate goiter, Suspected/coexisting thyroid malignancy or coexisting hyperparathyroidism needing surgery Present, ATD failure/relapse after proper treatment or severe adverse reaction Present, Moderate-severe active Graves orbitopathy Present, Child/adolescent Yes → Result: Preferred treatment Antithyroid drug (ATD)（Reason: ¹³¹I is contraindicated in pregnancy. In the first trimester prefer PTU, switching to MMI in the 2nd/3rd trimester, maintaining the minimum effective dose to keep FT4 near the upper normal limit; surgery in the 2nd trimester if drugs are not tolerated or rapid control is needed., Drug choice: MMI is preferred in most situations; use PTU in the first trimester, thyroid storm, severe cases, or MMI allergy; β-blockers relieve palpitations symptomatically, Caution: During ATD monitor liver function and white-cell count (beware agranulocytosis); ¹³¹I is contraindicated in pregnancy/lactation and used cautiously in moderate-severe active eye disease; surgery requires preoperative preparation） Inputs: Pregnancy No, Severity/goiter Huge goiter / compression, Suspected/coexisting thyroid malignancy or coexisting hyperparathyroidism needing surgery Absent, ATD failure/relapse after proper treatment or severe adverse reaction Absent, Moderate-severe active Graves orbitopathy Absent, Child/adolescent No → Result: Preferred treatment Surgery (subtotal/total thyroidectomy)（Reason: Markedly enlarged goiter with compression, suspected or coexisting malignancy, or coexisting hyperparathyroidism needing surgery favor surgery. Preoperatively use ATD to normalize thyroid function and add iodine to reduce intraoperative bleeding and thyroid-storm risk., Drug choice: MMI is preferred in most situations; use PTU in the first trimester, thyroid storm, severe cases, or MMI allergy; β-blockers relieve palpitations symptomatically, Caution: During ATD monitor liver function and white-cell count (beware agranulocytosis); ¹³¹I is contraindicated in pregnancy/lactation and used cautiously in moderate-severe active eye disease; surgery requires preoperative preparation）