Treatment of Hyperthyroidism

Treatment of High Thyroid Levels

Depending on the individual cause of hyperthyroidism, treatment may or may not be required for hyperthyroidism. Toxic multinodular goiter, Graves disease, and hot nodules are high-uptake diseases, are the most common forms of persistent hyperthyroidism, and usually require tailored hyperthyroid therapy. Different forms of thyroiditis may not need any therapy or only temporary treatments. When medical treatment is necessary, there are usually three ways to treat hyperthyroidism:

1) Oral medications

2) Surgery

3) Radioactive iodine

4) Beta Blockers

There has been speculation that patients gain weight with any treatment of hyperthyroidism. Dr. Jogi says "in the first 6 months of treatment, I request patients to plan to eat 30% less than usual and maintain a feeling of hunger at the end of all meals to avoid any weight changes." He thinks this is due to the slowing down back to metabolism of a normal human in addition to muscle quality wasting and loss that occurs during active hyperthyroidism. EGRET was a population based study (not a great study since not randomized but that may be hard to do on humans) which showed that radioactive iodine did no increased weight in patients. (1).

Oral Medications

Medications used to treat hyperthyroidism include Propylthiouracil (PTU), Methimazole (MMI), Steroids, Iodine, Propranolol and others. Depending on the cause and severity of the hyperthyroidism, different regimens and doses of these medicines are required. There can be significant side effects from these medications which can include liver damage, diabetes, infections, low blood-pressure and low thyroid levels so careful monitoring while on these medications is essential. Your physician may ask that you visit Since some of these side effects can be life-threatening, these medications are sometimes used as a bridge to more permanent treatments such as surgery or radioactive iodine. There are a percentage of patients that can go into "remission" from hyperthyroidism with these medications. The side effect may also include weight gain in some patients who become relatively hypothyroid.

Surgery

Surgery is occasionally offered to treat hyperthyroidism in those with very enlarged thyroid glands or who would otherwise not be candidates for therapy using medications or radioactive iodine. One hundred percent of patients that undergo surgery will become hypothyroid and will require medication for hypothyroidism. Medication therapy of hypothyroidism generally carries less side effects than the medications for hyperthyroidism. Surgery would be the quickest management of hyperthyroidism due to toxic multinodular goiter, Graves disease, or toxic hot nodule. The risks of surgical management for these forms of hyperthyroidism the rare side effect of permanent or temporary hypocalcemia from hypoparathyroidism, general anesthesia risks, and general surgical risks. The endocrinologists at Houston Thyroid and Endocrine will refer you to very experienced head and neck surgeons. The side effect may also include weight gain in some patients who become hypothyroid.

Radioactive iodine

Radioactive iodine is a mainstay in treating hyperthyroidism and is the most commonly used treatment for Graves' disease or toxic multinodular goiter which are the causes of the majority of cases of hyperthyroidism in the United States. It involves ingesting radioactive iodine, either in liquid or pill form which results in a painless, non-contagious, destruction of the overactive thyroid tissue over a three to six month period. This form of treatment is relatively safe and have been used for many decades to treat hyperthyroidism. It can and often does result in low thyroid levels which may require thyroid hormone treatment to once again normalize thyroid levels. The side effect may also include weight gain in some patients. We have a Radioactive Iodine Clinic for the benefit of our patients.

Beta blockers

This the name for a class of medications used to treat high blood pressure which can be used as an adjunctive therapy for the symptoms of hyperthyroidism. They are used in addition to the other treatments for hyperthyroidism. In addition to lowering blood pressure, beta blocker medications serendipitously happen to reduce the conversion of T4 to T3 in the peripheral tissues such as the heart, thereby reducing the negative effects of high thyroid levels. These medication also reduce the elevated heart rates that can be caused by high levels of thyroid hormone. The side effects of these medications include lowering blood pressure or heart rate too much, so your physician will need to adjust the doses accordingly.

References

(1) https://pubmed.ncbi.nlm.nih.gov/34598995/ BMJ Open . 2021 Oct 1;11(10):e055219. doi: 10.1136/bmjopen-2021-055219