Condition

Hyperthyroidism

Overactive thyroid gland

80M
People Affected
40
Active Trials
2.4M
New Cases/Year
5,000
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Total Thyroidectomy
98% Effectiveness• 95% Confidence• 40% Safety• 12 trials• 30K participants
HIGH EvidenceGood Value
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Comparative Safety Scale(Higher is safer)

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Meth💀
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40
DangerousModerateSafe

Time to Effect

Immediate (days-weeks for hormone normalization)

Duration

One-time surgery, lifelong levothyroxine

Response Rate

99%

Remission Rate

99%

Number Needed to Harm (NNH)

50

Common Side Effects:

Hypothyroidism (requires lifelong levothyroxine): 100%
Hypoparathyroidism (transient or permanent): 5%
Recurrent laryngeal nerve injury (hoarseness): 3%
Hematoma/bleeding: 1%
Infection: 1%

Annual Cost of Care

Drug Cost

$150

Monitoring

$600

Side Effects

$500

Total Annual

$4,250

Cost-Effectiveness

GOOD

QALYs Gained

1

ICER

$80,000/QALY

Cost per Remission

$4,337

Cost per Responder

$4,337

Treatment Outcomes
Primary Outcomes
Free Thyroxine (FT4)2.5 ng/dL
-80% (-2.0 ng/dL)
Thyroid Stimulating Hormone (TSH)0.01 mIU/L
+99900% (+9.99 mIU/L)
Hyperthyroid Symptom Severity (Likert Scale)25/30 points
-80% (-20 points)
Secondary Benefits
Resting Heart Rate95 bpm
-26.3% (-25 bpm)
Body Weight60 kg
+5% (+3 kg)
Health-Related Quality of Life (SF-36 Physical Component Summary)35 points
+42.86% (+15 points)
Common Side Effects
Hypothyroidism (requires lifelong levothyroxine)
+100%
Hypoparathyroidism (transient or permanent)
+5%
Recurrent laryngeal nerve injury (hoarseness)
+3%

Clinical Trial Phases:

Phase 4
2
Radioactive Iodine (I-131) Therapy
90% Effectiveness• 90% Confidence• 35% Safety• 1 trials• 100K participants
HIGH EvidenceExcellent ValueDose: 3-30 mCi (millicuries)
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Comparative Safety Scale(Higher is safer)

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35
DangerousModerateSafe

Time to Effect

6 weeks to 6 months

Duration

Single dose, lifelong monitoring and levothyroxine if hypothyroidism develops

Response Rate

90%

Remission Rate

90%

Common Side Effects:

Hypothyroidism (expected outcome, requires lifelong levothyroxine): 85%
Transient worsening of hyperthyroidism: 5%
Thyroiditis/neck pain: 5%
Dry mouth/eyes: 1%

Annual Cost of Care

Drug Cost

$750

Monitoring

$600

Side Effects

$100

Total Annual

$1,450

Cost-Effectiveness

EXCELLENT

QALYs Gained

1

ICER

$40,000/QALY

Cost per Remission

$1,611

Cost per Responder

$1,611

Treatment Outcomes
Primary Outcomes
Free Thyroxine (FT4)3.5 ng/dL
-71.4% (-2.5 ng/dL)
Thyroid Stimulating Hormone (TSH)<0.01 mIU/L
+30000% (+2.0-15.0 mIU/L)
Hyperthyroidism Symptom ScoreBillewicz Index: 25/30
-80% (-20 points)
Resting Heart Rate95 bpm
-21% (-20 bpm)
Secondary Benefits
Body Weight60 kg (for 1.7m height, indicating unintentional weight loss)
+10% (+6 kg)
Quality of Life (SF-36 Physical Component Score)30/100
+50% (+15 points)
Thyroid Gland Volume50 mL (moderate goiter)
-40% (-20 mL)
Common Side Effects
Hypothyroidism (expected outcome, requires lifelong levothyroxine)
+85%
Transient worsening of hyperthyroidism
+5%
Thyroiditis/neck pain
+5%

Clinical Trial Phases:

Phase 4
3
Methimazole
85% Effectiveness• 90% Confidence• 55% Safety• 31 trials• 80K participants
HIGH EvidenceExcellent ValueDose: Initial: 10-30 mg daily; Maintenance: 5-15 mg daily
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Comparative Safety Scale(Higher is safer)

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Meth💀
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55
DangerousModerateSafe

Time to Effect

1-2 weeks for symptom improvement, 4-8 weeks for hormone normalization

Duration

12-18 months typically, can be lifelong

Response Rate

90%

Remission Rate

50%

Number Needed to Harm (NNH)

2500

Common Side Effects:

Rash/itching: 15%
Arthralgia/myalgia: 5%
Nausea/vomiting: 5%
Agranulocytosis: 0.5%
Hepatotoxicity: 0.1%

Annual Cost of Care

Drug Cost

$200

Monitoring

$900

Side Effects

$100

Total Annual

$1,200

Cost-Effectiveness

EXCELLENT

QALYs Gained

1

ICER

$45,000/QALY

Cost per Remission

$2,400

Cost per Responder

$1,333

Treatment Outcomes
Primary Outcomes
Free Thyroxine (FT4)3.5 ng/dL
-65.7% (-2.3 ng/dL)
Thyroid Stimulating Hormone (TSH)0.01 uIU/mL (suppressed)
+9900% (+0.99 uIU/mL)
Resting Heart Rate105 bpm
-28.6% (-30 bpm)
Wayne's Clinical Index Score22 points
-72.7% (-16 points)
Secondary Benefits
Body Weight58 kg
+8.6% (+5 kg)
SF-36 Physical Functioning Score45 points (0-100 scale)
+33.3% (+15 points)
Fatigue Severity Scale (FSS)6.0 (1-7 scale)
-41.7% (-2.5)
Common Side Effects
Rash/itching
+15%
Arthralgia/myalgia
+5%
Nausea/vomiting
+5%

Clinical Trial Phases:

Phase 4
4
Propylthiouracil (PTU)
80% Effectiveness• 85% Confidence• 50% Safety• 2 trials• 50K participants
HIGH EvidenceGood ValueDose: Initial: 100-150 mg 3 times daily; Maintenance: 50 mg 2-3 times daily
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Comparative Safety Scale(Higher is safer)

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Meth💀
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50
DangerousModerateSafe

Time to Effect

1-2 weeks for symptom improvement, 4-8 weeks for hormone normalization

Duration

12-18 months typically, can be lifelong

Response Rate

85%

Remission Rate

40%

Number Needed to Harm (NNH)

750

Common Side Effects:

Rash/itching: 15%
Arthralgia/myalgia: 5%
Nausea/vomiting: 5%
Agranulocytosis: 0.5%
Severe Hepatotoxicity (can be fatal): 0.2%

Annual Cost of Care

Drug Cost

$400

Monitoring

$1,200

Side Effects

$200

Total Annual

$1,800

Cost-Effectiveness

GOOD

QALYs Gained

0.9

ICER

$55,000/QALY

Cost per Remission

$4,500

Cost per Responder

$2,118

Treatment Outcomes
Primary Outcomes
Free Thyroxine (FT4)3.0 ng/dL
-50% (-1.5 ng/dL)
Heart Rate105 bpm
-28.6% (-30 bpm)
Thyrotoxicosis Symptom Score24/30
-66.7% (-16 points)
Secondary Benefits
Thyroid Stimulating Hormone (TSH)0.01 uIU/mL
+14900% (+1.49 uIU/mL)
Anxiety (GAD-7 Scale)GAD-7 score: 18/21
-66.7% (-12 points)
Body Weight55 kg
+12.7% (+7 kg)
Common Side Effects
Rash/itching
+15%
Arthralgia/myalgia
+5%
Nausea/vomiting
+5%

Clinical Trial Phases:

Phase 4
5
Propranolol
75% Effectiveness• 95% Confidence• 70% Safety• 6 trials• 100K participants
HIGH EvidenceExcellent ValueDose: 10-40 mg 3-4 times daily
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Comparative Safety Scale(Higher is safer)

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Meth💀
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70
DangerousModerateSafe

Time to Effect

Hours to days for symptom control

Duration

Variable, often weeks-months adjunctively

Response Rate

85%

Remission Rate

%

Common Side Effects:

Bradycardia: 20%
Fatigue: 15%
Hypotension: 10%
Dizziness: 10%
Bronchospasm (in asthmatics): 1%

Annual Cost of Care

Drug Cost

$100

Monitoring

$100

Side Effects

$50

Total Annual

$250

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.4

ICER

$10,000/QALY

Cost per Responder

$294

Treatment Outcomes
Primary Outcomes
Resting Heart Rate105 bpm
-28.6% (-30 bpm)
Tremor Severity (VAS 0-10)6.5/10
-50% (-3.25 points)
Hamilton Anxiety Rating Scale (HARS)24/56
-45% (-10.8 points)
Systolic Blood Pressure145 mmHg
-13.8% (-20 mmHg)
Secondary Benefits
Palpitations Frequency (Self-reported, 0-5 scale)4/5
-60% (-2.4 points)
Overall Thyrotoxicosis Symptom Score (0-100)70/100
-40% (-28 points)
Common Side Effects
Bradycardia
+20%
Fatigue
+15%
Hypotension
+10%

Clinical Trial Phases:

Phase 4