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)