{ "schema_version": 1, "kind": "condition", "id": "hyperthyroidism", "name": "Hyperthyroidism (Thyrotoxicosis)", "category": "chronic", "sources": "ATA Guidelines for Diagnosis and Management of Hyperthyroidism 2016 · Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph) · Egyptian National Drug Formulary - Endocrine System 2024 (propylthiouracil monograph) · Hyperthyroidism - disease-level clinical article (hyperthyroidism-clinical.txt) · Egyptian National Drug Formulary - Cardiovascular 2024 (verapamil monograph)", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph) · Egyptian National Drug Formulary - Endocrine System 2024 (propylthiouracil monograph) · Hyperthyroidism - disease-level clinical article (hyperthyroidism-clinical.txt) · Egyptian National Drug Formulary - Cardiovascular 2024 (verapamil monograph)", "verified_date": "2026-08", "treatments": [ { "id": 975, "generic": "Carbimazole", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 5.0, "adult_dose": "Initial 20 to 60 mg/day given in 2 to 3 divided doses until euthyroid (4 to 8 weeks), then maintenance 5 to 15 mg once daily", "adult_duration": "12-18 months course", "dose_source": "Egyptian National Drug Formulary - Endocrine System 2024", "rationale": "Thionamide antithyroid drug that blocks thyroid peroxidase to reduce new thyroid hormone synthesis; first-line for hyperthyroidism outside the first trimester of pregnancy, where propylthiouracil is preferred instead.", "cautions": [ "WARN PATIENTS to report sore throat, fever, or mouth ulcers immediately (risk of agranulocytosis).", "Perform baseline full blood count before starting treatment.", "Avoid in 1st trimester of pregnancy (propylthiouracil preferred)." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children ≥3 years and Adolescents: Initial: 15 mg/day; adjust dose according to response.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "3 years and over", "age_min_months": 36, "age_max_months": 216, "dose_text": "Initial 15 mg daily; adjust dose according to response" } ], "peds_doses": null, "brands": [ { "trade_name": "THYROCARBIN 5 MG 100 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ROYAL LINK PHARMA", "price_egp": 107.0, "pack_count": 100, "unit_price": 1.07, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "THYROCARBIN 5 MG 50 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ROYAL LINK PHARMA", "price_egp": 55.0, "pack_count": 50, "unit_price": 1.1, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CARBIMAZOLE B.P 2007 5 MG 50 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 60.0, "pack_count": 50, "unit_price": 1.2, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NEOMERCAZOLE(CARBIMAZOLE) 5 MG 100 TABS. (ILLEGAL IMPORT)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMIDPHARM", "price_egp": 40.0, "pack_count": 100, "unit_price": 0.4, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "hyperthyroidism" }, { "id": 978, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Hyperthyroidism - disease-level clinical article (hyperthyroidism-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Thyroid storm - a life-threatening complication of untreated/undertreated hyperthyroidism with a mortality rate around 16% in patients over 60 - requires immediate recognition and urgent (emergency/ICU-level) management." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "hyperthyroidism" }, { "id": 977, "generic": "Propylthiouracil", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 50.0, "adult_dose": "300-400 mg daily in 3-4 divided doses until euthyroid, then titrate to maintenance 50-150 mg daily", "adult_duration": null, "dose_source": "Egyptian National Drug Formulary - Endocrine System 2024 (propylthiouracil monograph)", "rationale": "Thionamide antithyroid drug that blocks thyroid peroxidase like carbimazole but also reduces peripheral conversion of T4 to T3; preferred over carbimazole specifically in the first trimester of pregnancy despite its own risk of hepatotoxicity.", "cautions": [ "Propylthiouracil is the preferred antithyroid agent in the 1st trimester of pregnancy.", "There is a black box warning for severe, life-threatening hepatotoxicity; monitor LFTs.", "Report sore throat/fever immediately (agranulocytosis risk)." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children 6 to 10 years: initial 50 to 150 mg/day divided every 8 hours. Age ≥10 years: 150 to 300 mg/day divided every 8 hours. Maintenance: 50 mg twice daily.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "6 to 10 years", "age_min_months": 72, "age_max_months": 119, "dose_text": "50 to 150 mg daily, divided every 8 hours" }, { "label": "10 years and over", "age_min_months": 120, "age_max_months": 216, "dose_text": "150 to 300 mg daily, divided every 8 hours. Maintenance 50 mg twice daily." } ], "peds_doses": null, "brands": [ { "trade_name": "PROPYLTHIOURACIL 50MG 20 TAB. B.P 2002", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 14.0, "pack_count": 20, "unit_price": 0.7, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "THYROCIL 50 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 72.0, "pack_count": 30, "unit_price": 2.4, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "hyperthyroidism" }, { "id": 976, "generic": "Propranolol", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 10.0, "adult_dose": "10-40 mg three to four times daily PRN for rapid control of adrenergic symptoms (tachycardia, tremor, anxiety)", "adult_duration": null, "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph)", "rationale": "Non-selective beta-blocker added for rapid symptomatic control of the adrenergic features of thyrotoxicosis such as tachycardia and tremor; it does not affect thyroid hormone synthesis and does not replace the antithyroid drug.", "cautions": [ "Contraindicated in asthma and severe bronchospasm.", "This is symptomatic management only; it does not affect underlying thyroid hormone synthesis.", "Thyroid disease: May mask signs of hyperthyroidism (e.g., tachycardia). Monitor; gradual withdrawal when needed." ], "peds_mgkg_low": 0.25, "peds_mgkg_high": 0.5, "peds_max_mg": 40.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "0.25-0.5 mg/kg per dose, 3-4 times daily, under specialist guidance. The formulary ceiling is 1 mg/kg per dose four times a day; the 40 mg cap here is the adult per-dose maximum and binds first above 40 kg.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 2.5, "high_mg": 5, "capped": false }, { "weight_kg": 20, "low_mg": 5, "high_mg": 10, "capped": false }, { "weight_kg": 30, "low_mg": 7.5, "high_mg": 15, "capped": false }, { "weight_kg": 40, "low_mg": 10, "high_mg": 20, "capped": false } ], "brands": [ { "trade_name": "INDOLOL 10 MG 50 TAB", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 12.5, "pack_count": 50, "unit_price": 0.25, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PROLOL 10 MG 50 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 16.25, "pack_count": 50, "unit_price": 0.33, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "INDERAL 10 MG 50 TABS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ASTRA ZENECA", "price_egp": 75.0, "pack_count": 50, "unit_price": 1.5, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "hyperthyroidism" }, { "id": 979, "generic": "Verapamil", "line": 2, "is_adjunct": true, "form": "oral.solid", "strength_mg": 40.0, "adult_dose": "Immediate release: 40 mg 3 to 4 times daily, increased as needed for rate control (maximum 480 mg/day in 1 to 3 divided doses)", "adult_duration": "until euthyroid", "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (verapamil monograph)", "rationale": "Rate control for the patient who cannot take a beta-blocker; the card offered propranolol alone.", "cautions": [ "Do not use in patients with pre-excitation associated with an accessory pathway, to avoid ventricular arrhythmias.", "Contraindicated in AV block, cardiogenic shock, and acute porphyrias.", "Contraindicated in atrial flutter or fibrillation associated with accessory conducting pathways, e.g. Wolff-Parkinson-White syndrome.", "'Until euthyroid' is the clinical framing of the disease article, not a duration stated by the ENDF" ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The ENDF verapamil monograph gives no paediatric rate-control figure, so none is stated here.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "VERPAMIL 40MG 20 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 4.5, "pack_count": 20, "unit_price": 0.23, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VERATENS 40MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 3.5, "pack_count": 10, "unit_price": 0.35, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "hyperthyroidism" } ] }