Hyperthyroidism – Grade 2

Management escalation pathway

  • Persue ICPI
  • In the hyperthyroid phase, patients may benefit from beta blockers if symptomatic (e.g., atenolol 25–50 mg daily, titrate for HR < 90 if BP allows)
  • Monitor closely with regular symptom evaluation and free T4 testing every 2 weeks
  • Introduce thyroid hormones (see hypothyroidism management) if the patient becomes hypothyroid (low T4/T3, even if TSH is not elevated)
  • Graves’ disease should be treated per standard guidelines.

Assessment and Investigations


Autoimmune serology:

  • Anti-thyreoglobuline
  • Anti-thyreoperoxidase
  • TSI
  • Imaging
  • Thyroid echography (if nodules preset they should be further explored)
  • Medication history: amiodarone or lithium therapy


ADL: Activities of Daily Living
ICPi: Immune Checkpoint Blockade Inhibition
BP: Blood Pressure
HR: Heart Rate
T4: Thyroxine 4
TSH: Thyroid-Stimulating Hormone
FT4: Free Thyroxin