RAI is not given to pregnant women, as there are significant risks to the fetal thyroid development. Before getting pregnant, most doctors also recommend waiting from six months to a year after RAI to avoid any risk of residual radiation on the fetus.
Surgical TreatmentThyroid surgery -- known as thyroidectomy -- is considered the last choice in the United States for treating an overactive thyroid. Surgery is, however, recommended in certain situations:
- If antithyroid drugs and/or RAI have been unable to control the condition
- If a patient has suspicious nodules or thyroid cancer has already been found
- If a patient is experiencing an obstructed airway/difficulty breathing or swallowing
- If a patient is pregnant and not responding to antithyroid drugs
- If the patient has a very large goiter
Surgery is considered very effective and can provide rapid relief of symptoms to most patients, particularly when they have a large goiter and/or severe symptoms. Surgery is, however, invasive and has some risks, including hypoparathyroidism and damage to the laryngeal nerve. In the hands of an experienced surgeon, these risks are low, usually less than 3%. Surgical mortality from thyroid surgery is almost nonexistent.
Detailed information on thyroid surgery is featured in these articles:
- An overview of Thyroid Surgery
- Thyroid Surgery and Thyroidectomy: An In-depth Look
- Finding a Top Thyroid Surgeon
- Recuperating After Thyroid Surgery
- Complications After Thyroid Surgery
Beta BlockersWhile it's not a treatment for hyperthyroidism specifically, some people with hyperthyroidism are also treated with "beta adrenergic receptor antagonists" -- known more commonly as beta-blockers -- because they help alleviate the effects of excess thyroid hormone on the heart and circulation, especially rapid heart rate, blood pressure, palpitations, tremor and irregular rhythms. Beta blockers also reduce the breathing rate, reduce excessive sweating and heat intolerance and generally reduce feelings of nervousness and anxiety. Some beta-blockers also can help prevent T4-to-T3 conversion. They don't, however, slow the metabolic rate itself.
Propranolol (pronounced "proe PRAH no lall") is the most recommended and studied beta-blocker for hyperthyroidism. The most common brand name for propranolol is Inderal. While propranolol is considered the first beta-blocker to try for Graves' and hyperthyroidism patients, other beta-blockers sometimes given include atenolol (Tenormin) and metoprolol (Lopressor, Toprol XL).
The effects of most beta-blockers are usually fairly rapid, sometimes even within 10 to 15 minutes.
Beta blockers may not be recommended to patients with asthma, severe allergies, emphysema or any lung disease or bronchial conditions. Beta blockers also interact with a number of medications. You can check the interactions of any drugs at About.com's Drugs A to Z interactions checker.