Graves’ disease treatment options from the medical community

Doctors prescribe one or more of the three treatment options:  radioiodine therapy, antithyroid drugs, or thyroid surgery.  Radioiodine therapy is the most commonly used treatment for Graves’ disease in the United States.

Radioiodine Therapy

In radioiodine therapy, the patient takes radioactive iodine-131 by mouth.  Because the thyroid gland collects iodine to make thyroid hormone, it will collect the radioactive iodine from the bloodstream in the same way.  Iodine-131-stronger than the radioactive iodine used in diagnostic tests-will gradually destroy the cells that make up the thyroid gland but will not affect other tissues in the body.

Many doctors use a large enough dose of  iodine-131 to shut down the thyroid completely, but some prefer smaller doses to try to bring hormone production into the normal range.  More than one round of radioiodine therapy may be needed.  Results take time and a person undergoing this treatment may not notice improvement in symptoms for several weeks or months.

People with Graves’ ophthalmopathy should talk with their doctor about any risks associated with radioactive iodine treatments.  Several studies suggest that radioiodine therapy can worsen ophthalmopathy in some people.  Other treatments such as steroids may prevent this complication.

Although iodine-131 is knot known to cause birth defects or infertility, radioiodine therapy is not used in pregnant women or women who are breastfeeding.  Radioactive iodine can be harmful to the fetus’ thyroid, and it can be passed from mother to child in breast milk.

Almost everyone who receives radioactive iodine treatment eventually develops hypothyroidism, which occurs when the thyroid does not make enough thyroid hormone.  People with hypothyroidism must take synthetic thyroid hormone.

Medications

Doctors may prescribe a drug called a beta blocker to reduce symptoms until other treatments take effect.  Beta blockers act quickly to relieve symptoms such as hand tremors, rapid heart beat, and nervousness.  These drugs act by blocking the effects of thyroid hormone on the body, but they do not stop thyroid hormone production.

Two antithyroid drugs, methimazole and propylthiouracil (PTU), interfere with the way the thyroid gland uses iodine to make thyroid hormones.  Doctors sometimes use antithyroid drugs as the only treatment for Graves’ disease, but these drugs usually do not produce permanent results and their use requires frequent monitoring by a health care provider.  More often, antithyroid drugs are used to pretreat patients older than 60 of those who have other health problems before beginning radioiodine therapy, or as a supplemental treatment after radioiodine therapy.

Because pregnant and breastfeeding women cannot receive radioiodine therapy, they are usually treated with an antithyroid drug instead.  Pregnant women should not take methimazole and should be monitored if they take PTU.  Women who are breastfeeding should take the smallest dose necessary of either drug.

Antithyroid drugs can cause side effects in some people.  Allergic reactions such as rashes and itching are the most common side effects.  Rarely, antithyroid drugs cause liver failure or a decrease in the number of white blood cells, which can lower resistance to infection.

Thyroid Surgery

Surgery is the least-used option in treating Graves’ disease.  However, doctors sometimes choose surgery to treat pregnant women who cannot tolerate antithyroid drugs, people in whom thyroid cancer is suspected, or those who fail other forms of treatment.  Graves’ disease itself does not cause cancer.

When surgery is used, many doctors recommend the entire thyroid be removed, thus eliminating the chance that hyperthyroidism will return.  If the entire thyroid is removed, lifelong thyroid hormone replacement is necessary.

Although uncommon, certain problems can occur in thyroid surgery.  The parathyroid glands could be damaged because they are located very close to the thyroid gland.  These glands help control calcium levels in the body.  Damage to the laryngeal nerve, also located close to the thyroid gland, could lead to voice changes or breathing problems.  When surgery is performed by an experienced surgeon, less than 1 percent of patients have permanent complications.

• January 12, 2009 -- What are the symptoms of Grave’s disease?
  People with Graves' disease may have some of the common symptoms of  hyperthyroidism such as: nervousness or irritability fatigue or muscle weakness heat intolerance trouble sleeping hand tremors rapid and irregular heartbeat frequent bowel movements or diarrhea weight loss goiter, which is an enlarged thyroid that may cause the neck to look swollen In addition, the eyes of ...
• January 20, 2010 -- How Is Graves’s Disease Diagnosed?
  Graves' disease diagnosed Doctors can sometimes diagnose Graves' disease based only on a physical examination and a medical history.  Laboratory test confirm the diagnosis. The ultrasensitive TSH test is usually the first test a doctor performs.  This test detects even tiny amounts of TSH in the blood and is the most accurate measure of thyroid activity available.  Another blood test used to...