Treatment
Temporary or transient forms of hyperthyroidism are usually treated symptomatically, but Graves' disease and hyperthyroidism There are three main treatment approaches for hyperthyroidism.- Drug treatment with antithyroid drugs, including methimazole (brand name Tapazole), carbimazole (Neo-Mercazole), and propylthiouracil (PTU)
- Ablation of the thyroid gland with radioactive iodine (RAI)
- Surgery to remove all or part of the thyroid
The treatment approach for Graves' disease and hyperthyroidism is controversial, because outside the US, doctors tend to start with antithyroid drugs, and then move on to either surgery or RAI. RAI is usually avoided, however, for women of childbearing age, and children. Interestingly, it's thought that a third to a half of patients may achieve a remission with the use of antithyroid drugs.
In the US, doctors tend to push for RAI as a first-line treatment. Antithyroid drugs are sometimes used, but not as commonly as outside the US Surgery is reserved primarily as a backup for situations where RAI and medication fail.
There are some new approaches, including a procedure called thyroid arterial embolization, that are gaining interest and may play a role in treatment in the future.
Natural health practitioners also recommend various natural, alternative medicine, and integrative approaches to Graves' disease and hyperthyroidism.
A comprehensive look at the key treatment options is outlined in the article Treatment of Graves' Disease/Hyperthyroidism
Coping with Graves Disease/Hyperthyroidism
One very important factor is to find the right doctor for your thyroid care, and to work effectively with that practitioner. Many people suffering from Graves' disease or hyperthyroidism -- especially those who might undergo RAI or surgery -- should consider receiving care from an endocrinologist.Women need to be aware that there are special concerns and recommendations for women with Graves' disease or hyperthyroidism who are pregnant, trying to conceive, or breastfeeding -- or women who find themselves with hyperthyroidism during pregnancy.
After RAI or surgery, most patients do become permanently hypothyroid, and require lifelong thyroid hormone replacement medication. Some patients still consider themselves hyperthyroid or as having Graves' disease, not realizing that in fact, their thyroid condition is now hypothyroidism.
Once hypothyroid, however, patients need to focus on many of the concerns affecting people with hypothyroidism, including preventing weight gain or losing weight, and proper use of thyroid hormone replacement medication.
With new information coming out all the time, an important coping strategy is also to stay informed.
There are also resources online for support for people with Graves' disease and hyperthyroidism.
Advice and helpful strategies on how to live with Graves' disease and hyperthyroidism, and living well after treatment, are featured in Coping with Graves' Disease/Hyperthyroidism.
Sources:
AACE Thyroid Task Force, "American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Hyperthyroidism and
Hypothyroidism," Endocrine Practice, Vol 8 No. 6, November/December 2002
Braverman, MD, Lewis E., and Robert D. Utiger, MD. Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text. 9th ed., Philadelphia: Lippincott Williams & Wilkins (LWW), 2005.
De Groot, Leslie, M.D., Thyroid Disease Manager, Online book. Online
Moore, Elaine A. with Lisa Moore. Graves' Disease A Praactical Guide. McFarland & Company, Inc., North Carolina, 2001
Shomon, Mary J., Living Well With Graves' Disease and Hyperthyroidism: What Your Doctor Doesn't Tell You...That You Need to Know , HarperCollins, New York 2005, Online
Weetman, Anthony P. "Graves' Disease" New England Journal of Medicine , Volume 343:1236-1248 October 26, 2000 Number 17
