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Hyperthyroidism

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21 76. Following thyroidectomy for TMNG, serum calcium ± iPTH levels should be measured, and oral calcium and calcitriol supplementation administered based on the results. (W-L) 77. MMI should be stopped at the time of surgery for TMNG or TA. β-adrenergic blockade should be slowly discontinued following surgery. (S-L) 78. Following thyroidectomy for TMNG, thyroid hormone replacement should be started at a dose appropriate for the patient's weight (0.8 mcg/lb or 1.6 mcg/kg) and age, with elderly patients needing somewhat less. TSH should be measured every 1–2 months until stable, and then annually. (S-L) 79. Following lobectomy for TA, TSH and estimated free T 4 levels should be obtained 4–6 weeks after surgery, and thyroid hormone supplementation started if there is a persistent rise in TSH above the normal range. (S-L) 80. RAI therapy should be used for retreatment of persistent or recurrent hyperthyroidism following inadequate surgery for TMNG or TA. (S-L) ATDs 81. Long-term MMI treatment of TMNG or TA might be indicated in some elderly or otherwise ill patients with limited life-expectancy, in patients who are not good candidates for surgery or ablative therapy, and in patients who prefer this option. (W-L) Ethanol or Radiofrequency Ablation 82. Alternative therapies such as ethanol or radiofrequency ablation of TA and TMNG can be considered in select patients where RAI, surgery or long-term ATD are inappropriate, contraindicated, or refused, and expertise in these procedures is available. (N-In)

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