| Hyperthyroidism (also known an overactive thyroid) | | | | shows agranulocytosis, patients must remain off the |
| occurs when the thyroid gland produces excessive | | | | antithyroid drugs. The white blood cells usually return to |
| thyroid hormones. This causes many of the body's | | | | normal within one to two weeks. |
| functions to speed up. About 2 in 100 women, and 2 in | | | | Beta-blocker Medicines |
| 1000 men, develop hyperthyroidism at some stage of | | | | There are medications available to immediately treat |
| their life. | | | | the symptoms caused by excessive thyroid |
| Treatment of Overactive Thyroid | | | | hormones, such as a rapid heart rate. One of the main |
| Three forms of treatment are available for | | | | classes of drugs used to treat these symptoms is the |
| hyperthyroidism. Each of them have their own | | | | beta-blockers (e.g., Inderal, Tenormin, Lopressor). Some |
| advantages and limitations and physicians prefer one | | | | people take a beta-blocker medicine for a few weeks |
| over the other due to reasons of simplicity, cost and | | | | whilst the level of thyroxine is reduced gradually by |
| availability and also on the severity of hyperthyroidism, | | | | one of the available treatments. |
| existing illnesses and the age of patient. Each of the | | | | Indications and Benefits: |
| possible treatments for an overactive thyroid have | | | | - Prompt relief of the adrenergic symptoms of |
| some advantages and some disadvantages. In general, | | | | hyperthyroidism such as tremor, palpitations, heat |
| all three treatments are highly effective and | | | | intolerance, and nervousness. |
| associated with a low risk of side effects. | | | | - Treatment of choice for thyroiditis |
| Drug Therapy | | | | - First line therapy before surgery, radioactive iodine, |
| Drug therapy includes the use of beta-blocking agents | | | | and antithyroid drugs |
| and antithyroid drugs. | | | | - Short term therapy in pregnancy |
| Antithyroid Drugs (ATD) | | | | Disadvantages, Risks and Possible Side Effects: |
| Most patients with hyperthyroidism are given | | | | - Must be used with caution in older patients and in |
| antithyroid drugs as initial therapy. There are two main | | | | patients with pre-existing heart disease, chronic |
| antithyroid drugs available for use in the United States: | | | | obstructive pulmonary disease, or asthma. |
| methimazole (Tapazole) and propylthiouracil (PTU). | | | | Radioactive Iodine (Radioiodine) |
| They interfere with the ability of the thyroid gland to | | | | The thyroid cells are the only cells in the body that are |
| synthesize its hormones and are usually given in high | | | | able to absorb iodine. By giving radioactive iodine, cells |
| doses until the thyroid gland functions normally | | | | in the thyroid are damaged or destroyed and are |
| (becomes euthyroid). This can take one to two | | | | unable to produce further thyroid hormone. Radioiodine |
| months. PTU is preferred in pregnant hyperthyroid | | | | therapy involves taking a drink, or swallowing a |
| patients. | | | | capsule, which contains radioactive iodine. The dose of |
| Indications and Benefits: | | | | radioactivity to the rest of the body is very low and is |
| - availability and simplicity | | | | not dangerous. |
| - ATD drugs work well to control the overactive | | | | Indications and Benefits: |
| thyroid, bring prompt control of hyperthyroidism, and do | | | | - Inexpensive, highly effective, easy to administer, and |
| not cause permanent damage to the thyroid gland | | | | safe |
| - may be used for long-term treatment of Graves' | | | | - High cure rates with single-dose treatment (80%) |
| disease. | | | | - Treatment of choice for Graves' disease, multinodular |
| - PTU is preferred choice in pregnant women with | | | | goiter, toxic nodules in patients older than 40 years, |
| overactive thyroid | | | | and relapses from antithyroid drugs |
| - preferred treatment by many endocrinologists for | | | | Disadvantages, Risks and Possible Side Effects: |
| children and for adults who refuse radioactive iodine | | | | - Delayed control of symptoms |
| - pretreatment of older and cardiac patients before | | | | - Posttreatment hypothyroidism in majority of patients |
| radioactive iodine or surgery | | | | with Graves' disease regardless of dosage |
| - both medications (methimazole and PTU) considered | | | | - Contraindicated in patients who are pregnant or |
| safe for use while breastfeeding | | | | breastfeeding |
| Disadvantages, Risks and Possible Side Effects: | | | | - Can cause transient neck soreness, flushing, and |
| - High relapse rate (relapse is more likely in smokers, | | | | decreased taste |
| patients with large goiters, and patients with positive | | | | - Radiation thyroiditis in 1% of patients |
| thyroid-stimulating antibody levels at the end of | | | | - May exacerbate Graves' ophthalmopathy |
| therapy). Hyperthyroid condition returns in about half of | | | | - May require pretreatment with antithyroid drugs in |
| all patients. | | | | older or cardiac patients |
| - PTU can cause elevated liver enzymes, and | | | | - Treatment of hyperthyroidism in children remains |
| immunoallergic hepatitis | | | | controversial |
| - Methimazole can cause rare cholestasis and rare | | | | - Reluctance to use in women of childbearing years |
| congenital abnormalities | | | | Surgery |
| - Minor side effects include rash, fever, gastrointestinal | | | | In a situation where radioiodine is not available and the |
| effects, and arthralgia | | | | patient is not responding to ATD patients are |
| - Rare side effect is called "agranulocytosis". This is a | | | | subjected to a surgery. Surgery (thyroidectomy) |
| condition in which the white blood cells, which fight | | | | involves removing part of the thyroid gland. It may be a |
| infection, disappear from the body. This could be a | | | | good option if you have a large goitre (thyroid swelling) |
| serious problem if an infection developed while those | | | | which is causing problems in the neck. If too much of |
| white blood cells were low. Fortunately, there is usually | | | | the thyroid is removed it is not usually a problem as |
| a warning when you get agranulocytosis - a fever and | | | | you can take thyroxine tablets to keep the thyroxine |
| a sore throat. Patients on antithyroid drugs who | | | | level normal. It is usually a safe operation, although as |
| develop a fever and a sore throat should stop the pills | | | | with all operations there is a small risk. This mode of |
| and call right away to get a blood test. If the blood test | | | | treatment requires 5-10 days of hospitalization. |