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Because many of the manifestations of hyperthyroidism appear to be mediated by the

^-adrenergic system, ^-adrenergic blockers are used to rapidly relieve palpitations,

tremor, anxiety, and heat intolerance. Because ^-blockers do not reduce the synthesis of thyroid hormones, they are used only until more specific antithyroid therapy is effective. Since nonselective agents can impair the conversion of T4 to T3, propranolol and nadolol are used. An initial propranolol dose of 20 to 40 mg four times daily should be titrated to relieve signs and symptoms. ^-Blockers should not be used in patients with decompensated heart failure or asthma. When a contraindication to ft-blockers exists, clonidine or diltiazem may be used.

FIGURE 44-3. Features of Graves' disease. (A) Facial appearance: exophthalmos, lid retraction, periorbital edema, and proptosis. (B) Thyroid dermopathy over lateral aspects of shins. (C) Thyroid clubbing (acropachy). (From Jameson JL, Weetman AP. Disorders of the thyroid gland. In: Kasper DL, Braunwald E, Fauci AS, et al., eds. Harrison's Principles of Internal Medicine, 16th ed. New York: McGraw-Hill, 2004:2114.)

FIGURE 44-3. Features of Graves' disease. (A) Facial appearance: exophthalmos, lid retraction, periorbital edema, and proptosis. (B) Thyroid dermopathy over lateral aspects of shins. (C) Thyroid clubbing (acropachy). (From Jameson JL, Weetman AP. Disorders of the thyroid gland. In: Kasper DL, Braunwald E, Fauci AS, et al., eds. Harrison's Principles of Internal Medicine, 16th ed. New York: McGraw-Hill, 2004:2114.)

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