Hypothyroid

The basic goal of treatment is to return thyroid hormone levels to normal.

Hyperthyroidism makes the body work too fast because there is too much thyroid hormone in the blood. Graves’ disease is the most common cause of hyperthyroidism. Graves’ disease occurs because of a problem in the body’s immune system: antibodies are produced that overstimulate the thyroid gland.

Patients who are hyperthyroid from taking too much thyroid hormone need only to have their dosage properly adjusted.

Patients whose hyperthyroidism is caused by transient thyroiditis usually do not require any of the treatments described below, since their condition gets better on its own.

Treatment for hyperthyroidism from Graves’ disease, toxic autonomously functioning thyroid nodule, or toxic multi-nodular goiter may include one or more of the following:

Radioactive iodine (I¹³¹)

Radioactive iodine shrinks an enlarged thyroid or toxic nodule or nodules that are making too much thyroid hormone. This treatment is safe and is widely used in adults with hyperthyroidism.

* Radioactive iodine (I¹³¹) is the treatment of choice for the majority of the endocrinologists in this country. It is an effective, simple, safe way to treat patients with Graves’ disease or other forms of hyperthyroidism. Patients often have fears and misconceptions about using radioactive iodine.

* Studies have been done since the 1940’s on patients receiving this treatment. Treated patients, their children, and their grandchildren do not have an increased incidence of cancer, leukemia, etc.

* There are no increased instances of birth defects in children born to mothers who have had this treatment and waited the recommended time before becoming pregnant. (Pregnancy should be avoided for at least six months after the treatment.) As a matter of fact, fertility is often restored to women whose infertility is due to hyperthyroidism. Treating the disease also lessens the chance of miscarriage.

* Pregnant women should not be given radioactive iodine for any reason. If a patient has any doubt as to whether she is pregnant, treatment (and testing) with radioactive iodine should be delayed.

* Hospitalization is not required in order to treat hyperthyroidism with radioactive iodine.

* Radioactive iodine treatment ablates the thyroid gland (turns it into something like a dried-up raisin). Patients wishing to avoid destruction of the gland should know that the thyroid gland frequently “burns out” within 15 years even without treatment.

* Radioactive iodine does not cause a person to gain weight. However, because Graves’ disease increases the metabolism, patients should keep in mind that they cannot continue to eat the way they did while hyperthyroid. Because of changes in the metabolism after hyperthyroidism is treated, many patients will gain weight . This weight can be lost through diet and exercise once the thyroid levels are normalized.

Antithyroid drugs

Propylthiouracil (PTU)
Tapazole®

Antithyroid drugs, such as propylthiouracil (PTU) and methimazole (Tapozole®), are used in patients with Graves’ disease and, less commonly, in other hyperthyroid patients

Surgery (thyroidectomy)

In some cases beta-blocking drugs are prescribed to treat the symptoms of hyperthyroidism while waiting for one of the above treatments to work.

Your doctor will be able to discuss the benefits and risks of each treatment.

Many patients treated for hyperthyroidism become hypothyroid. They will need to take thyroid hormone pills for the rest of their lives. In addition, they will need to see their doctor at least once a year.

® Tapozole is a registered trademark of Jones Medical Industries.

Signs and symptoms of Hyperthyroidism may include:

• fast heart rate (100-120 beats per minute or higher)
• slightly elevated blood pressure
• nervousness or irritability
• increased perspiration
• muscle weakness (especially in the shoulders, hips, and thighs)
• trembling hands
• weight loss, in spite of a good appetite
• hair loss
• fingernails partially separated from finger-tips (onycholysis)
• swollen fingertips (achropachy or clubbing)
• retracted (pulled back) upper eyelids
• skin changes
• increased frequency of bowel movements
• goiter (an abnormal swelling in the neck caused by an enlarged thyroid gland)
• in women, decreased menstrual flow and less frequent menstrual flow
• in men, slight swelling of the breasts
• in Graves’ disease: thick or swollen skin over the shin bones (pretibial myxedema); eyes that seem to be popping out of their socket (exophthalmos).

Most of these conditions will return to normal after the hyperthyroidism is treated. Certain others may be treated separately.

Chronic thyroiditis

Called Hashimoto’s thyroiditis, it is by far the most common form. It begins so slowly that most people don’t know anything is wrong. Over time, the disease destroys thyroid tissue until permanent hypothyroidism results. Some patients with Hashimoto’s have normal thyroid functions (euthyroidism) with a goiter.

Subacute thyroiditis

It’s a less common form, with far fewer cases than in chronic thyroiditis. Often caused by a viral infection, the disease lasts for several months. Subacute thyroiditis is painful, causing a tender, swollen thyroid gland with pain throughout the neck. The pain usually responds to treatment with aspirin or other anti-inflammatory drugs. At first, gland destruction causes the release of stored thyroid hormones, inducing temporary hyperthyroidism. A month or two later, the patient may become hypothyroid, because the thyroid has been damaged and its hormone reserves used up. Most patients return to normal within six to nine months, but the hypothyroidism could be permanent.

Painless thyroiditis

It causes a painless swelling of the thyroid gland. When this disease occurs after pregnancy, it is called postpartum thyroiditis. The course of painless thyroiditis is otherwise similiar to painful subacute thyroiditis.

Acute thyroiditis

A rare disease, is caused by an acute infection. Patients with the disease become very sick and have a high fever. The neck is red, hot, and very tender. Acute thyroiditis is a medical emergency and must be treated with antibiotics and surgery.