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Main > Specialty Areas > Endocrinology >
Hyperthyroidism Treatments
The options for treating hyperthyroidism include:
Treating the symptoms
Antithyroid drugs
Radioactive iodine
Surgery treating symptoms (discussed on the next page)
Treating the symptoms
There are medications available to immediately treat the symptoms mentioned above. One of the main classes of drugs used to treat these symptoms is the beta-blockers (e.g., Inderal, Tenormin, Lopressor). These medications counter the effect of thyroid hormone to increase metabolism, but they do not alter the levels of thyroid hormones in the blood. A doctor determines which patients to treat based on a number of variables including the underlying cause of hyperthyroidism, the age of the patient, the size of the thyroid gland, and the presence of coexisting medical illnesses.
Antithyroid Drugs
There are 2 main antithyroid drugs available,
Methimazole (Tapazole)
Propylthiouracin (PTU).
These drugs accumulate in the thyroid tissue and block production of thyroid hormones. PTU blocks the conversion of T4 hormone to the more metabolically active T3 hormone.
| The major risk of anti-thyroid medications such as Methimazole (Tapazole) or Propylthiouracin is the occasional suppression of production of white blood cells by the bone marrow (agranulocytosis). (White cells are needed to fight infection.) It is impossible to tell if and when this side effect is going to occur, so regular determination of white blood cells in the blood are not useful. |
It is important for patients to know that if they develop a fever, a sore throat, or any signs of infection while taking methimazole or propylthiouracil, they should see a doctor immediately. While a concern, the actual risk of developing agranulocytosis is less than 1%. In general, patients should be seen by the doctor at monthly intervals while taking antithyroid medication.
The dose is adjusted to maintain the patient in as close to a normal thyroid state as possible. Once the dosing is stable, patients can be seen at three month intervals if long-term therapy is planned.
Usually, long-term antithyroid therapy is only used for patients with Graves' disease, since this disease may actually go into remission under treatment without requiring treatment with thyroid radiation or surgery. When the disease is in remission, the gland is no longer overactive, and antithyroid medication is not needed.
Recent studies also have shown that adding a pill of thyroid hormone to the antithyroid medication actually results in higher remission rates. The rationale for this may be that by providing an external source for thyroid hormone, higher doses of antithyroid medications can be given, which may suppress the overactive immune system in persons with Graves' disease. This type of therapy remains controversial, however. When long-term therapy is withdrawn, patients should continue to be seen by the doctor every 3 months for the first year, since a relapse of Graves' disease is most likely in this time period. If a patient does relapse, antithyroid drug therapy can be restarted, or radioactive iodine or surgery may be considered.
Radioactive Iodine
Radioactive iodine is given orally (either by pill or liquid) on a one-time basis to ablate a hyperactive gland. The iodine given for ablative treatment is different from the iodine used in a scan. Radioactive iodine is given after a routine iodine scan, and uptake of the iodine is determined to confirm hyperthyroidism. The radioactive iodine is picked up by the active cells in the thyroid and destroys them. Since iodine is only picked up by thyroid cells, the destruction is local, and there are no widespread side effects with this therapy. Radioactive iodine ablation has been safely used for over 50 years, and the only major reasons for not using it are pregnancy and breast-feeding.
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| Random Useful Tip: |
Epinephrine shot If you are known to have a severe anaphylactic reaction, carry an epinephrine (adrenaline) shot with you at all times. Pay attention to expiration date and replace it regularly: upon expiration, it loses its effectiveness. |
| Random Drug Info: |
Levothyroxine Levothyroxine is a pure synthetic form of T4 hormone that is made in a laboratory to be an exact replacement for the T4 that the human thyroid gland normally secretes. It comes in multiple strengths, which means that an appropriate dosage can almost always be found for each patient. |
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