Beta Blockers for Hyperthyroidism Maintenance

First-Line Beta Blocker Options

• Propranolol is the most widely studied and recommended beta blocker for symptomatic management of hyperthyroidism, with atenolol being an effective alternative when a more cardioselective agent is preferred, as recommended by the American Heart Association 1, 2
• Atenolol (25-50 mg daily, titrated for heart rate <90 if blood pressure allows) is an effective cardioselective alternative, particularly beneficial when non-selective beta blockade is contraindicated, according to the American College of Cardiology 3, 4

Clinical Considerations

• For thyrotoxicosis (thyroid storm), beta blockers are essential for controlling cardiovascular symptoms, as stated by the European Society of Cardiology 5, 6

Special Populations

• In pregnant women with hyperthyroidism, propranolol can be used safely for symptom control, as recommended by the American Academy of Family Physicians 7
• In patients with atrial fibrillation due to hyperthyroidism, beta blockers are first-line therapy for rate control, according to the American College of Cardiology 5, 6
• For patients with hyperthyroidism and heart failure, beta blockers should be used cautiously as they may precipitate worsening heart failure, as warned by the American Heart Association 8

Monitoring and Follow-up

• For patients with immune checkpoint inhibitor-induced thyroiditis, monitor thyroid function every 2 weeks as the condition may progress to hypothyroidism, as recommended by the Society for Immunotherapy of Cancer 3, 4, 9