The Benefits of Yoga for Hypothyroidism

What do antithyroid drugs do?

Antithyroid drugs block pathways leading to thyroid hormone production.

Antithyroid drugs used in this country are Propylthiouracil (PTU) and Tapazole®. Some physicians will recommend antithyroid medication as a first line of treatment to see if the patient is one of the lucky 30% of patients who go into a remission after taking antithyroid medication for one to two years. (Patients are said to be in remission if their hyperthyroidism does not recur after discontinuing the antithyroid drugs.) If antithyroid drugs do not work for the patient, then physicians usually recommend radioactive iodine.

Antithyroid drugs are also used to treat very young children, older patients with heart conditions, and pregnant women. For severe or complicated cases of hyperthyroidism, especially in older patients, PTU or Tapazole® can be given for four to six weeks to bring the hyperthyroidism under better control prior to administering radioactive iodine treatment.

In cases when women are diagnosed with Graves’ disease while they are pregnant, PTU is prescribed. The smallest dose possible is given because the medication does cross over to the fetus. The mother should be checked every three to four weeks during the pregnancy so that the lowest possible dose can be given. Too much PTU can cause fetal goiter, hypothyroidism, and mental retardation.

® Tapozole is a registered trademark of Jones Medical Industries.

Are there any side effects?

Antithyroid drugs cause side effects in about 10% of patients. Reactions can include:

• skin rash
• swollen, stiff, painful joints
• sore throat and fever
• low white blood count, which can lead to serious infections
• jaundice (yellow coloring of the skin) and, rarely, liver failure.

Most side effects clear up once the drugs are stopped. If you think you are having a reaction to anti-thyroid drugs, call your doctor immediately.

What can be expected with antithyroid drug treatment?

• Several pills are taken from one to four times a day, every day for six to 24 months.
• Some patients complain that the pills have an unpleasant smell and taste.
• There is usually some symptom relief within one to two weeks. In some cases, it can take several months to relieve symptoms.
• Antithyroid drugs have a relatively low success rate. While PTU or Tapazole® may correct the problem temporarily or for a few years, the chances of a permanent remission are about 30% once the drugs are stopped.
• The likelihood of achieving a permanent remission is increased if the patient takes the medication for one to two years.
• There are side effects in 10% of the people treated with Tapazole® or PTU. These are:
  • skin rash over most of the body swollen, stiff, painful joints
  • sore throat and fever — if this happens, the antithyroid drugs should be stopped immediately and the physician contacted
  • jaundice
  • liver damage, which is fatal in rare cases
• Because antithyroid drugs pass into breast milk, only PTU in a dosage less than 200 mg a day is advised if the baby is not weaned.
• Within 15 years, the thyroid gland may burn out, resulting in hypothyroidism, and the patient will need thyroid hormone replacement.

When is surgery performed?

Surgery (thyroidectomy) is the primary treatment for suspected thyroid cancer and can be used to treat hyperthyroidism. Surgery is used to remove large goiters that make breathing or swallowing difficult. Occasionally, a goiter may be removed for cosmetic reasons.Can you tell me more about cancer surgery?

If thyroid cancer is suspected, your doctor will recommend surgery. The surgeon usually removes only one lobe of the thyroid, unless cancer is confirmed at surgery. A section of the gland is tested during surgery (frozen section) to tell the surgeon whether it is cancerous (malignant) or not cancerous (benign). If it is malignant, all or most of the thyroid is removed. If the cancer has spread outside of the thyroid, lymph nodes in the neck may also have to be removed. In addition, radioactive iodine therapy may be needed six weeks after surgery to destroy any remaining cancer tissue.

How is the cancer surgery operation done?

The operation is usually performed under general anesthesia and takes about two hours. After surgery, patients may stay in the hospital for up to three days. They may also need to take some time off from work (a week or two for a desk job and three to four weeks for physical labor).

Are there any risks to thyroid surgery?

Thyroid surgery is a safe treatment. However, as with any surgery, there are risks. About 1% of patients develop problems with normal speech caused by damage to nerves leading to the voice box, which lies very close to the thyroid. Occasionally, there may be damage to the parathyroid glands, which control the level of calcium in the blood. If this happens, the patient will need to take calcium and other medicines to prevent future problems. Minor risks of surgery include infection, bleeding, and a scar. The chance of death is very small.

What can be expected with thyroid surgery?

• Patients will be in the hospital for one to three days.
• Surgery is usually done under general anesthesia and lasts about two hours.
• A small cut approximately three to four inches long is made along the natural crease of the neck.
• After going to the recovery room for a few hours, patients are returned to their rooms. Patients can usually get out of bed, eat, and have visitors the evening of the surgery.
• It can take up to a year for the scar to heal and the redness to disappear.
• Because most of the thyroid gland is removed, some patients will have to begin lifelong thyroid hormone replacement.

What are the possible complications of thyroid surgery?

• The four parathyroid glands located around the thyroid gland can be accidentally damaged causing low calcium levels that can lead to muscle spasms, convulsions, and the formation of cataracts, if untreated.
• Minor voice changes are not uncommon, but only 1% of those operated on have major voice problems. The nerves from the larynx (voice box) are very near the thyroid gland and sometimes pass through the gland. It is sometimes unavoidable that they are damaged during surgery.
• As with any surgery, there is the risk of surgical death, bleeding, and infection.

One of the more psychologically unpleasant and frustrating side effects that can occur with either hyperthyroidism or hypothyroidism is hair loss. There is no way to predict which patients will experience hair loss and which will not. Similarly, there is no way to predict who will be severely affected and who will have only minimal hair loss.

Because each person is unique, responses to thyroid disease and treatment will vary. This can be disturbing to patients who have lost a great deal of hair and want to know exactly when this will stop and when their hair will be normal again.

Here are a few facts to remember if you experience hair loss because of hyperthyroidism or hypothyroidism:

• Hair loss from thyroid disease is usually reversible with proper treatment of the thyroid condition.
• Typically hair loss does not immediately stop when the blood work becomes normal. Most people stop losing their hair and begin replacing lost hair a few months after the thyroid hormone levels become normal. In some cases, it can take longer.
• Stress can contribute to hair loss. Because of the nature of thyroid disease, it can have a direct impact on the psychological well-being of patients, particularly on the coping mechanisms that deal with stress. Unfortunately, as patients become more and more concerned about their hair loss, their stress levels increase, making the situation worse.
• It is advisable to take caution when considering chemical treatments of the hair-for example, coloring or permanent waves. If at all possible, avoid such treatments until the hair loss has stopped.
• Cutting the hair shorter, using moisturizing and conditioning hair products, and avoiding back combing are other methods to decrease stress on the hair.

The most important things you can do to minimize further hair loss are to faithfully take prescribed thyroid medications and to be calm and patient.