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.
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
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
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.
Potential Side Effects
Blocks synthesis of T3 & T4.
Does not block release of stored T4 & T3. (Action is generally quicker than
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.