Management

HYPERTHYROIDISM– MANAGEMENT

The main goals of treatment are to:

  • restore normal blood levels of thyroid hormones
  • prevent complications
  • educate the person to identify the warning signs of the disease early

Treatment

Hyperthyroidism can be treated with medications, surgery and radioactive iodine therapy. Symptoms like sweating, increased heart rate, shakiness or tremor, anxiety (adrenergic symptoms) can be controlled by beta-blockers (such as Propranolol) till the time Antithyroid drugs act.

Treatment of Grave’s disease:

The disease can be treated by:

  • Antithyroid medicines
    • Medications like Methimazole, Carbimazole and Propylthiouracil decreases the production of thyroid hormone.
    • Initially full dose of Methimazole (30-40 mg) or Propylthiouracil (300-400 mg) are given orally until the patient becomes euthyroid (i.e. normal thyroid function). Once the thyroid hormone levels become normal, the dose is gradually decreased to a level where the patient remains in a euthyroid state.
    • These drugs may take 6 weeks to 3 months to stabilize the thyroid hormone levels in blood.
    • Propylthiouracil may be safer in pregnant women.
  • Surgery: Subtotal thyroidectomy (surgical removal of most of the thyroid gland) may be considered in:
    • young people
    • people who have a large goiter
    • those who are allergic to or develop severe side effects to antithyroid drugs.

Patient should be treated with Antithyroid drugs to make them euthyroid before surgery. At times due to excess removal of thyroid gland a hypothyroidism like state may set in. In such cases, thyroid hormone replacement therapy is indicated.

  • Radioactive iodine:
    • It may take 2-3 months to show improvement after a single dose of radio active iodine.
    • It is a preferred mode of treatment in older people (> 40 years of age).
    • It does not increase the risk of thyroid cancer, leukemia or other cancers. However, it should be avoided during pregnancy due to risk to fetus.

Treatment of Plummer’s disease

The treatment options may be:

  • Surgery (removal of thyroid or just the over active or hyperfunctioning nodule)
    • Usually recommended in patients under 40 years of age.
    • It not only cures hyperthyroidism rapidly but also relieves symptoms due to pressure of enlarged thyroid on trachea (wind pipe) or esophagus (food pipe).
  • Radioactive iodine
    • In Plummer’s disease larger dose of radioactive iodine is required as the thyroid cells are relatively radio resistant (i.e. do not respond to radioactive iodine therapy).

Treatment of thyroid storm

  • Thiourea drug (propylthiouracil or methimazole), Lugol’s solution (potassium iodide plus iodine) or sodium iodide are commonly used drugs.
  • Beta blockers (to be used cautiously in the presence of heart failure) and corticosteroids may also be used.

Education

It is essential to know and identify the signs and symptoms of Hyperthyroidism early. If any of these symptoms are noticed immediately consult the doctor:

  • Constant nervousness and restlessness
  • Tremors or “shakes”
  • Increased sweating
  • Intolerance to heat
  • Frequent bowel movements
  • Weight loss in spite of normal or increased appetite
  • Muscle weakness or wasting
  • Menstrual irregularities
  • Palpitations, shortness of breath, or chest pain
  • Bulging eyes