Beta-Blocker in Grave's disease

Q: Which Beta-Blocker (BB) is usually preferred in Grave's disease? (select one)

A) Atenolol

B) Esmolol

C) Carvedilol 

D) Timolol 

Answer: Atenolol

BB in Graves' hyperthyroidism ameliorates the symptoms. Although any BB can be used Atenolol is preferred for two reasons

1. It requires only a single daily dosing 

2. It is beta-1 selective

Beta-blockers effectively control palpitations, tachycardia, tremulousness, anxiety, heat intolerance, fatigability, and shortness of breath. Patients who get BB added to thionamide respond better in controlling these symptoms in comparison to thionamide alone.

Esmolol (choice B) is only available as intravenous and is usually used only in ICU/anesthesia settings. Carvedilol (choice C)  is preferred in the management of congestive heart failure. Timolol (choice D) is preferred in ophthalmology as eye drops.

#endocrinology

References:

1. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016; 26:1343.

2. Geffner DL, Hershman JM. Beta-adrenergic blockade for the treatment of hyperthyroidism. Am J Med 1992; 93:61.

3. Tagami T, Yambe Y, Tanaka T, et al. Short-term effects of β-adrenergic antagonists and methimazole in new-onset thyrotoxicosis caused by Graves' disease. Intern Med 2012; 51:2285.