doctor’s choice of treatment will be influenced by your age, the type of
hyperthyroidism that you have, the severity of your hyperthyroidism, and
other medical conditions that may be affecting your health. It may be
a good idea to consult with a physician who is experienced in the
treatment of hyperthyroid patients. If you are unconvinced or unclear
about any thyroid treatment plan, a second opinion is a good idea.
Antithyroid drugs
Drugs known as antithyroid agents—methimazole (Tapazole®) or
propylthiouracil (PTU)—may be prescribed if your doctor chooses to
treat the hyperthyroidism by blocking the thyroid gland’s ability to make
new thyroid hormone. These drugs work well to control the overactive
thyroid, bring prompt control of hyperthyroidism, and do not cause
permanent damage to the thyroid gland. In about 20% to 30% of patients
with Graves’ disease, treatment with antithyroid drugs for a period of 12
to 18 months will result in prolonged remission of the disease. For
patients with toxic nodular or multinodular goiter, antithyroid drugs are
used in preparation for either radioiodine treatment or surgery.
Antithyroid drugs cause allergic reactions in about 5% of patients who
take them. Common minor reactions are red skin rashes, hives, and
occasionally fever and joint pains. A rarer (occurring in 1 of 500
patients), but more serious side effect is a decrease in the number of
white blood cells. Such a decrease can lower your resistance to
infection. Very rarely, these white blood cells disappear completely,
producing a condition known as agranulocytosis, a potentially fatal
problem if a serious infection occurs. If you are taking one of these
drugs and get an infection such as a fever or sore throat, you should
stop the drug immediately and have a white blood cell count that day.
Even if the drug has lowered your white blood cell count, the count
will return to normal if the drug is stopped immediately. But if you
continue to take one of these drugs in spite of a low white blood cell
count, there is a risk of a more serious, even life-threatening infection.
Liver damage is another very rare side effect. You should stop the drug
and call your doctor if you develop yellow eyes, dark urine, severe
fatigue, or abdominal pain.
Radioactive iodine
Another way to treat hyperthyroidism is to damage or destroy the
thyroid cells that make thyroid hormone. Because these cells need
iodine to make thyroid hormone, they will take up any form of iodine
in your blood stream, whether it is radioactive or not. The radioactive
iodine used in this treatment is administered by mouth, usually in a
small capsule that is taken just once. Once swallowed, the radioiodine
gets into your blood stream and quickly is taken up by the overactive
thyroid cells. The radioiodine that is not taken up by the thyroid cells
disappears from the body within days. It is either eliminated in the urine
or transformed by radioactive decay into a nonradioactive state. Over a
period of several weeks to several months (during which time drug
treatment may be used to control hyperthyroid symptoms), radioactive
iodine damages the cells that have taken it up. The result is that the
thyroid or thyroid nodules shrink in size, and the level of thyroid
hormone in the blood returns to normal. Sometimes patients will
remain hyperthyroid, but usually to a lesser degree than before. For them,
a second radioiodine treatment can be given if needed. More often,
hypothyroidism (an underactive thyroid) occurs after a few months. In
fact, most patients treated with radioactive iodine will become
hypothyroid after a period of several months to many years.
Hypothyroidism can easily be treated with a thyroid hormone
supplement taken once a day (see the Hypothyroidism brochure).
Radioactive iodine has been used to treat patients for hyperthyroidism
for over 60 years. Because of concern that the radioactive iodine might
somehow damage other cells in the body, produce cancer, or have other
long-term unwanted effects such as infertility or birth defects, the
physicians who first used radioiodine treatments were careful to treat
only adults and to observe them carefully for the rest of their lives.
Fortunately, no complications from radioiodine treatment have become
apparent over many decades of careful follow-up of patients. As a result,
in the United States more than 70% of adults who develop
hyperthyroidism are treated with radioactive iodine. More and more
children are also being treated with radioiodine.
Surgery
Your hyperthyroidism can be permanently cured by surgical removal
of most of your thyroid gland. This procedure is best performed by a
surgeon who has much experience in thyroid surgery. An operation
could be risky unless your hyperthyroidism is first controlled by an
antithyroid drug (see above) or a beta-blocking drug (see below).
Usually for some days before surgery, your surgeon may want you to
take drops of nonradioactive iodine—either Lugol’s iodine or
supersaturated potassium iodide (SSKI). This extra iodine reduces the
blood supply to the thyroid gland and thus makes the surgery easier
and safer. Although any surgery is risky, major complications of thyroid
surgery occur in less than 1% of patients operated on by an experienced
thyroid surgeon. These complications include damage to the
parathyroid glands that surround the thyroid and control your body’s
calcium levels (causing problems with low calcium levels) and damage
to the nerves that control your vocal cords (causing you to have a
hoarse voice).
After your thyroid gland is removed, the source of your hyperthyroidism
is gone and you will likely become hypothyroid. As with hypothyroidism
that develops after radioiodine treatment, your thyroid hormone levels
can be restored to normal by treatment once a day with a thyroid
hormone supplement.
Beta-blockers
No matter which of these three methods of treatment you have for your
hyperthyroidism, your physician may prescribe a class of drugs known
as the beta adrenergic blocking agents that block the action of thyroid
hormone on your body. They usually make you feel better within hours,
even though they do not change the high levels of thyroid hormone in
your blood. These drugs may be extremely helpful in slowing down your
heart rate and reducing the symptoms of palpitations, shakes, and
nervousness until one of the other forms of treatment has a chance to
take effect. Propranolol (Inderal®) was the first of these drugs to be
developed. Some physicians now prefer related, but longer-acting betablocking
drugs such as atenolol (Tenormin®), metoprolol (Lopressor®)
and nadolol (Corgard®), and Inderal-LA® because of their more
convenient once- or twice-a-day dosage.
Other family members at risk
Because hyperthyroidism, especially Graves’ disease, may run in families,
examinations of the members of your family may reveal other
individuals with thyroid problems.
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