Rosh Pediatrics Practice Exam

What is the best initial therapy for managing hyperthyroidism in a 13-year-old girl with a thyroid disorder?

1. AMethimazole

2. BPropranolol

3. CPropylthiouracil

4. DRadioactive iodine

The correct answer is: AMethimazole

The best initial therapy for managing hyperthyroidism in a 13-year-old girl is methimazole. Methimazole is an antithyroid medication that effectively reduces the production of thyroid hormones by inhibiting the enzyme thyroperoxidase, which is involved in the synthesis of thyroid hormones. This makes it a suitable choice for young patients, as it has a favorable side-effect profile compared to other options such as propylthiouracil, which can cause liver toxicity and is typically not the first-line treatment in adolescents. When initiating treatment for hyperthyroidism, especially in a pediatric patient, it is essential to opt for medications that have a longer-term safety profile and are easier to use. Methimazole can be administered once daily, which helps improve adherence. Moreover, it is often effective in inducing remission in cases of Graves’ disease, the most common form of hyperthyroidism in children. Propranolol serves primarily as a symptomatic treatment for controlling palpitations and anxiety associated with hyperthyroidism rather than addressing the underlying hormonal imbalance. Radioactive iodine is typically considered for older patients or when other treatments have failed, as it leads to long-term hypothyroidism, requiring lifelong thyroid hormone replacement. Using these considerations