ATA Guidelines Tools

7 ATDs 13. Methimazole (MMI) should be used in virtually every patient who chooses ATD therapy for GD, except during the first trimester of pregnancy when propylthiouracil (PTU) is preferred, in the treatment of thyroid storm, and in patients with minor reactions to MMI who refuse RAI therapy or surgery. (S-M) 14. Patients should be informed of side effects of ATDs and the necessity of informing the physician promptly if they should develop pruritic rash, jaundice, acolic stools or dark urine, arthralgias, abdominal pain, nausea, fatigue, fever, or pharyngitis. (S-L) • Preferably, this should be in writing. • Before starting ATDs and at each subsequent visit, the patient should be alerted to stop the medication immediately and call their physician when there are symptoms suggestive of agranulocytosis or hepatic injury. 15. Prior to initiating ATD therapy for GD, the ATA suggests that patients have a baseline complete blood count, including white count with differential, and a liver profile including bilirubin and transaminases. (W-L) 16. A differential white blood cell count should be obtained during febrile illness and at the onset of pharyngitis in all patients taking antithyroid medication. (S-L) 17. There is insufficient evidence to recommend for or against routine monitoring of white blood cell counts in patients taking ATDs. (N-In) 18. Liver function and hepatocellular integrity should be assessed in patients taking MMI or PTU who experience pruritic rash, jaundice, light-colored stool or dark urine, joint pain, abdominal pain or bloating, anorexia, nausea, or fatigue. (S-L) 19. There is insufficient information to recommend for or against routine monitoring of liver function tests in patients taking ATD's. (N-In) 20. Minor cutaneous reactions may be managed with concurrent antihistamine therapy without stopping the ATD. Persistent symptomatic minor side effects of antithyroid medication should be managed by cessation of the medication and changing to RAI or surgery, or switching to the other ATD when RAI and surgery are not options. In the case of a serious allergic reaction, prescribing the alternative drug is not recommended. (S-L)

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