Options for Treatment of Hyperthyroidism
Patients with Graves' Disease Have Choices When it Comes to Thyroid
Sep 22, 2009
Hyperthyroidism or an overactive thyroid, occurs when the thyroid produces too much thyroid hormone. Symptoms of hyperthyroidism include:
- unexplained weight loss
- palpitations or racing heart
- hot flashes or heat intolerance
- fatigue
- insomnia
- anxiety or irritability
- shakiness
Evaluation of these symptoms will include thyroid blood tests to check levels of TSH, T4 and T3, as well as thyroid antibody tests. Once Graves' hyperthyroidism is confirmed, different treatment options must be considered.
Anti-Thyroid Medications
Anti-thyroid medications block excess thyroid hormone production. Two medications are primarily used, methimazole (Tapazole, Northyx) and propylthiouracil (PTU). The goal for medication treatment is to achieve remission with normal thyroid function. Most patients are started on methimazole due to better outcomes. However, PTU is used first in pregnant patients with Graves' disease due to the small possibility of adverse effects to the fetus if methimazole is used.
Side effects of both medications include rash, headache, stomach upset. Liver funtion tests will be monitored due to the possibility of elevation of liver enzymes while on the medications. If liver tests elevate on the medication, the dose should be lowered or discontinued to prevent drug-induced hepatitis. There is a very rare side effect of agranulocytosis where the patient's white blood cell count drops, making them more susceptible to infection. Patients should call their prescriber if they develop a sore throat or fever.
Patients with hyperthyroidism are often started on methimazole 10 mg to 20 mg daily. The dose is slowly tapered once the thyroid begins to stabilize. Eventually, the medication is discontinued once the thyroid function tests are normal. The course of treatment for hyperthyroidism is usually one to two years.
Radioactive Iodine Ablation for Hyperthyroidism
Radioactive iodine is used frequently to treat hyperthyroidism in the United States. A dose of iodine is given that knocks out thyroid function. Most patients become hypothyroid instead and require llifelong thyroid hormone replacement. Radioactive iodine cannot be used in pregnant patients or women who are breast-feeding. Women are usually advised to wait at least six months after treatment before becoming pregnant.
Most patients tolerate the treatment well, though hyperthyroidism can initially worsen after iodine is administered. The full effects of the iodine may take up to six months. Patients with thyroid eye disease should see an opthalomologist before radioactive iodine treatment. Sometimes, steroid dosing is necessary temporarily to protect the eyes immediately before and after iodine ablation.
Thyroid Surgery
Thyroidectomy may be considered in certain circumstances for Graves' patients. The entire thyroid must be removed to cure hyperthyroidism. This approach is used in patients with:
- thyroid eye disease
- significantly enlarged thyroid or thyroid nodules
- concerns about radiation treatment
- patients who do not tolerate antithyroid medications
Hyperthyroidism is a treatable condition. Patients with Graves' disease shold consider all available options for treatment and discuss the risks and benefits of each with their healthcare provider.
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