There are several treatments for hyperthyroidism, including therapies that decrease the symptoms and those that stop the over-activity of the thyroid. The exact treatment depends on the cause of the hyperthyroidism. Some causes of hyperthyroidism do not need treatment, as left alone Mother Nature will eventually fix the problem.
Beta-blockers
Beta-blocker medications such as propranolol can be used to lessen the symptoms of hyperthyroidism. Propranolol is generally a short-term medication that is stopped once the underlying cause of hyperthyroidism has been corrected. People who have a history of asthma should not take propranolol or any other beta-blocker.
Anti-thyroid medications, radioactive iodine and surgery
Therapies that decrease the activity of the thyroid include anti-thyroid medications, radioactive iodine, or surgical removal of part or all of the thyroid. Surgery was one of the first treatments for hyperthyroidism and is still used today in some situations.
Anti-thyroid medications and radioactive iodine are the more common treatments for hyperthyroidism. The decision to use either therapy depends on many factors, including:
- the underlying cause of your hyperthyroidism
- your age
- what other medical conditions you might have
- whether you are pregnant or breast-feeding
- what country you live in
- your own personal beliefs and wishes
Radioactive iodine is very effective in correcting an over-active thyroid and, in North America, it is the most common treatment for people suffering from hyperthyroidism due to Graves' disease. Radioactive iodine can be taken orally, is tasteless and painless, and does not require hospitalization. Any extra radioactive iodine not absorbed by the thyroid is promptly excreted by the kidneys. In many ways, it is similar to removing the thyroid without surgery. However, radioactive iodine can induce an under-active thyroid, causing patients to require lifelong replacement with thyroid hormone. For this reason, some people choose anti-thyroid medications.
Anti-thyroid medications include methimazole, carbimazole, and propylthiouracil (PTU). They are all similar in that they decrease the thyroid's ability to make thyroid hormone. These drugs do not treat the underlying cause of the thyroid disease but instead control the excessive production of thyroid hormone. Generally, they are prescribed for 6 to 18 months and then stopped so your physician can determine if the underlying immune attack on the thyroid has ceased. Unfortunately, hyperthyroidism remains in remission without drugs less than 50% of the time.
Anti-thyroid medications have a number of potential side effects. Two are important to be aware of. The first is a rash which occurs in about 5% of people. The rash goes away when the pills are stopped, but it generally means you have to choose another method of treating the hyperthyroidism. The other important side effect is "agranulocytosis" or a decrease in white blood cells. White blood cells are the body's main line of defense against infection. A decrease or loss of white blood cells means that the body will not be able to fight off infection and a severe infection can result. Fortunately this is a rare complication that occurs in approximately 1 in 500 people. When it does occur it is very serious and invariably requires hospitalization and intravenous antibiotics. If untreated, it could be fatal.
Surgical treatment of Graves' disease is rarely called for today. An example of when this would be necessary would be to treat a pregnant woman who is allergic to anti-thyroid drugs.
Therapeutic options to correct hyperthyroidism:
- radioactive iodine
- anti-thyroid pills
- surgery to remove part or all of the thyroid
Will iodine tablets, kelp or seaweed supplements help?
Iodine often makes hyperthyroidism worse. As iodine is necessary for the body to make thyroid hormone, adding additional iodine to your diet may be like throwing gasoline on a smoldering fire. It is important to discuss any home remedies or health food supplements for the thyroid with your doctor prior to taking them.
What if I'm pregnant or planning to get pregnant?
Pregnant women should not take radioactive iodine as this could affect the thyroid of an unborn baby. Anti-thyroid drugs can be taken during pregnancy and surgery is sometimes recommended.
The timing of future pregnancies will affect the choice of therapy for hyperthyroidism. If radioactive iodine has been used, most physicians will recommend not becoming pregnant for 6-12 months. Whatever therapy you choose, the ideal situation is to be drug free, with normal levels of thyroid hormone in your body before getting pregnant.
Dr.
Richard Bebb, MD
in association with the MediResource Clinical Team
