Hyperthyroidism

 



Treatments

  
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Treatment Options

There are three main options for treatment of hyperthyroidism:  Surgery, Radioactive Iodine administration and Drug therapy.  Each option has advantages and disadvantages, but both Surgery and Radioactive Iodine treatments destroy or remove thyroid tissue potentially requiring the patient to take thyroid replacement hormones for the rest of their life.  Drug therapy preserves the thyroid tissue, but only provides a permanent solution for 25-40% of individuals.

Surgery


Full or partial removal of the thyroid is an effective and quick solution for hyperthyroidism.  The disadvantage of this option is that surgery always carries some level of risk and that removal of the thyroid will require the patient to take thyroid replacement hormone for the rest of their life.  The Surgery option is usually recommend for people that have not responded to Drug Therapy and may not qualify for the Radioactive Iodine therapy.  

Radioactive Iodine Therapy


Radioactive Iodine Therapy is the most common treatment for Hyperthyroidism because of the low incidence of side effects and effectiveness.  In this treatment, the patient is given pill of radioactive Iodine.  Most of orally ingested iodine will make its way to the thyroid, so as the radioactive iodine accumulates in the Thyroid gland, the radiation will destroy thyroid tissue.  The intent of the treatment is to destroy enough tissue to bring thyroid production back down normal levels.  However, approximately 80% of patients will still require lifelong thyroid replacement therapy.



Antithyroid Drugs


Two thioamide drugs are available for treatment of hyperthyroidism, Methimazole and propylthiouracil. Both prevent production of thyroid hormones and reduce circulating thyroid hormone levels after only a few weeks of therapy.  Treatment with antithyroid drugs usually lasts 8-16 months and causes remission of hyperthyroidism in 20-40% of patients.  This real disadvantage of this treatment option is the low cure rate compared to surgery or Radioactive Iodine Therapy.  When the treatment is successful however, there is no need for lifetime thyroid hormone replacement therapy.  Methimazole is the preferred options because of its quicker action and fewer side effects. 

   

Drug

Action

Potential Side Effects

Methimazole (Tapazole)



  

Blocks synthesis of T3 & T4.

Does not block release of stored T4 & T3. (Action is generally quicker than Proylthiouracil)

Hepatotoxicity

Nephrotic syndrome

Leukopenia

Peripheral Neuropathy

Neuritis

Vertigo

Rash

Arthralgia

Alopecia

Pruitus

Drowsiness

Hypothyroidism

   

   

Propylthiouracil


 

Blocks synthesis of T4 & T3.   Does not block release of stored T4 & T3. (Existing stores of Thyroid Hormone must be utilized before circulating thyroid hormone levels are affected.

Lymphadenopathy

Thrombocytosis

Leukopenia

Edema

Bradycardia

Fatigue

Depression

Dizziness

Vertigo

Muscle cramps

Weight Gain

Rash

Urticaria

Pruritus

Paresthesias

Headache

Drowsiness

Nausea

Vomiting

Diarhea