A patient with hyperthyroidism presents with anxiety, palpitations, and weight loss. What is the first course of treatment?

In the management of hyperthyroidism, particularly when presenting symptoms such as anxiety, palpitations, and weight loss, the initial approach often involves addressing the immediate symptoms as well as the underlying condition. Starting a beta-blocker like metoprolol is a common first step because it can effectively alleviate symptoms such as palpitations and anxiety associated with hyperthyroidism due to its rapid action in reducing heart rate and controlling symptoms of adrenergic overstimulation.

Alongside this, the use of antithyroid medication such as propylthiouracil (PTU) is appropriate as it addresses the hyperthyroid state by reducing thyroid hormone production. This dual approach not only stabilizes the patient’s immediate symptoms but also begins to correct the underlying hyperthyroidism.

Other treatments, such as radioactive iodine or thyroidectomy, are typically considered for longer-term management of hyperthyroidism but are not appropriate as initial interventions in an acute setting. Referring the patient to psychiatry, while potentially beneficial if there are ongoing mental health concerns, does not address the immediate physical symptoms and the underlying hyperthyroid condition. Therefore, initiating treatment with metoprolol and PTU addresses both symptom relief and the management of the disorder effectively.