From Mary Shomon,
Your Guide to Thyroid Disease.
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Recommended treatment approaches depend on the type of thyroid disease you have, and in some cases, the severity of the condition. This article provides an overview of the treatment approaches for key thyroid conditions, as well as information on the specific treatments.

HYPOTHYROIDISM/HASHIMOTO'S DISEASE

Hypothyroidism is a condition where the thyroid is underactive, chemically destroyed, or surgically removed, and therefore unable to produce sufficient levels of thyroid hormone. Hypothyroidism is treated by replacing the missing hormone, a hormone that is essential to the body’s key functions. This is accomplished by taking thyroid hormone replacement drugs prescribed by a physician.

Treatment of Hashimoto’s disease, the autoimmune condition that often results in hypothyroidism, is more controversial. Some practitioners believe that Hashimoto’s requires no treatment, and will only treat a patient with thyroid hormone replacement drugs when the Hashimoto’s has resulted in hypothyroidism that can be verified through laboratory testing. (The distinction is outlined in the article Hashimoto's vs. Hypothyroidism: What's the Difference? A Look at Autoimmune Thyroid Disease and Underactive Thyroid Conditions.)

Some practitioners believe that Hashimoto’s, which can be confirmed by testing for thyroid antibodies, warrants treatment in some patients. There is some evidence that treating Hashimoto’s disease with thyroid hormone replacement drugs before the thyroid stimulating hormone (TSH) level rises may alleviate some symptoms. Some research suggests that treating someone with Hashimoto’s but a normal TSH may help prevent elevation of the TSH level and progression to full hypothyroidism. This is discussed further in Treating Hashimoto's When the TSH is Normal.

On the integrative medicine front, some holistic practitioners recommend iodine supplementation, other nutritional supplements, dietary changes, particular yoga poses, mind-body medicine, and other complementary approaches to help the thyroid.

HYPERTHYROIDISM / GRAVES’ DISEASE

Hyperthyroidism is a condition where the thyroid gland is overactive, and produces an excess of thyroid hormone. The gland becomes overactive primarily due to autoimmune Graves’ disease, or in some cases due to thyroid nodules that produce excess thyroid hormone, or viral illness.

Hyperthyroidism is treated by reducing the excess hormone levels, which is accomplished in three different ways:

• antithyroid drugs
• radioactive iodine treatment (RAI), also known as radioiodine ablation
• surgical removal of all or part of the thyroid, known as thyroidectomy
• block/replace therapy (BRT)
• thyroid arterial embolization

The approach used for treatment depends on the severity of the condition, whether or not the patient is a child or a pregnant woman, and in some cases, the preference or perspective of the treating physician. There are also differences in approaches between the United States and other countries in terms of the treatments used. In the United States, surgery is rarely done for hyperthyroidism (except for pregnant women), and RAI is the treatment of choice, to the extent that some patients may not even be informed that antithyroid drugs or surgery are options. In Europe, however, antithyroid drug therapy is likely to be a practitioner’s first choice for treatment.

Interest is also growing in thyroid arterial embolization, a new approach for Graves' disease treatment.

In some cases, key hyperthyroidism symptoms such as rapid heart rate or elevated blood pressure are also treated with drugs known as beta-blockers.

Most thyroid patients who receive RAI treatment or have surgery eventually end up hypothyroid, and are treated with thyroid hormone replacement drugs.

Some integrative practitioners recommend stress reduction programs, antithyroid dietary and nutritional changes, traditional Chinese medicine, and other holistic approaches to help an overactive thyroid.

THYROID STORM

Thyroid storm is a rare but potentially life-threatening complication of hyperthyroidism. When this condition is suspected, immediate treatment needs to be obtained at an emergency room.

THYROIDITIS

Thyroiditis refers to an inflammation of the thyroid. While autoimmune (Hashimoto’s) thyroiditis is common, there are other forms of thyroiditis, including post-partum thyroiditis, De Quervain's (also called subacute or granulomatous) thyroiditis, and viral thyroiditis, among others.

As noted, in some cases, Hashimoto’s thyroiditis is treated with thyroid hormone replacement drugs. For cases of thyroiditis that are painful, doctors typically recommend a pain-reliever with anti-inflammatory properties, such as aspirin, ibuprofen (Advil/Motrin), or naproxen (Aleve).

If the thyroiditis is especially acute, doctors occasionally recommend steroid drugs to reduce inflammation, along with thyroid hormone replacement drugs, to allow the thyroid to rest from its job of hormone production.

Holistic practitioner Stephen Langer, M.D., has shared his recommendations regarding nutritional supplements helpful in treating thyroiditis.

On the nutritional front, there is some evidence that supplementing with the mineral selenium may help thyroiditis.

GOITER

A goiter is the term used for an enlarged thyroid. Goiter can develop in both hypothyroidism and hyperthyroidism.

A goiter can cause a variety of symptoms, including a feeling of fullness in the neck, pain, and less commonly, may wrap around the trachea, making it difficult to swallow or even breathe.