How should I manage a patient with hyperthyroidism who is experiencing significant symptoms but has contraindications to antithyroid medications?

In cases where a patient with hyperthyroidism has significant symptoms but contraindications to antithyroid medications, consider **supportive treatment with beta-blockers** to manage adrenergic symptoms, especially in the early stages before definitive treatment ¹.

**Arrange urgent specialist assessment** to evaluate other definitive treatment options such as radioactive iodine or surgery, particularly if symptoms are severe or if there are concerns about the underlying cause ¹.

**Discuss with the patient** the possible benefits and risks of all treatment options, including radioactive iodine and surgery, and involve them in shared decision-making ¹.

If antithyroid drugs are contraindicated, **radioactive iodine treatment** is a first-line definitive treatment for adults with Graves' disease unless contraindicated (e.g., active orbitopathy, pregnancy, or breastfeeding) ¹.

**Thyroid surgery** may be considered, especially if there are large goitres, suspicion of malignancy, or intolerance to medical therapy, and should be performed by a high-volume thyroid surgeon ¹.