How is hyperthyroidism treated?
Your doctor will treat your hyperthyroidism based on your symptoms and test results. The goal of treatment is to improve symptoms through reducing thyroid hormone levels. The choice and length of treatment depends on the cause of hyperthyroidism, and how well the treatment controls the symptoms.
Graves’ disease requires initial treatment with anti-thyroid medication for 18 months. Graves’ disease returns in approximately half of patients, usually within the first two years of stopping anti-thyroid medication. If this happens, treatment options to consider are radioactive iodine therapy or surgery for permanent control of Graves’ disease, or an anti-thyroid medication long term, as tolerated.
The treatment of thyroiditis depends on its cause. If it is due to an autoimmune condition, or occurs post-partum, anti-thyroid medications are not effective. The thyroiditis usually settles spontaneously, but other medications (beta-blockers) can be used to manage hyperthyroid symptoms. The thyroiditis may return and can, in the long-term, cause permanent hypothyroidism.
If viral thyroiditis is diagnosed on the basis of a ‘sore throat/thyroid’, high fever, body aches and pains and blood test results, anti-inflammatory medication can be helpful. In more severe cases, a medication (prednisolone) can be given to reduce pain, inflammation and swelling. Thyroid function generally returns to normal over several weeks.
Drug-induced causes of thyroiditis are treated according to the drug concerned.
If thyroid nodules are present, excess iodine intake may contribute to hyperthyroidism. This means it may be important to avoid iodine if possible. Your endocrinologist will be able to discuss this further with you.
Single or multiple nodules
Single or multiple nodules that actively produce excess thyroid hormones are best treated with radioactive iodine therapy or surgery. Anti-thyroid medications can be used in preparation for surgery, or in people who are not well enough to have either surgery or radioactive iodine therapy. If an anti-thyroid medication is used for these particular patients, the treatment must be continued indefinitely, and is not the preferred treatment.
If your thyroid hormone production is too high, an anti-thyroid medication (carbimazole or propylthiouracil) may be given. This medication reduces the production of thyroid hormones. The length of treatment depends on the cause of hyperthyroidism. Anti-thyroid medications can have minor side-effects in some people, including painful joints, nausea, rash, itching or hives. In rare cases, bone marrow toxicity may occur, so it is important to tell your doctor if you have any fever, sore throat, skin rash or mouth ulcers. Your doctor will advise to stop taking this medication until the result of a full blood examination is known. Regular blood tests will be ordered by your doctor, once you start an anti-thyroid medication to check hormone levels return to a normal range.
Radioactive iodine may be used to reduce thyroid hormone production by destroying some or all of the thyroid gland. For most patients, this is a single treatment, taken as a pill that releases radioactive iodine. The thyroid gland absorbs the iodine, and the radiation damages and destroys the overactive thyroid cells. Other parts of your body are not affected by the radiation, as they do not use iodine like the thyroid gland. Symptoms generally improve within a month, although the radioactive iodine keeps working for about 6 months. If symptoms continue after 6 to 12 months or anti-thyroid medications are still required, a second dose might be needed. Sometimes thyroid hormones levels drop too low and lifelong thyroid hormone replacement (levothyroxine) therapy is needed to bring levels back to normal.
This treatment should not be used if you are pregnant, considering pregnancy over the next 6 months or breast feeding. Caution should also be given if the patient has significant thyroid eye disease.
Surgery is sometimes required if too much thyroid hormone is being produced by the thyroid gland, which cannot be controlled by an anti-thyroid medication or radioactive iodine treatment or surgery is the preference of the person with hyperthyroidism. For Graves’ disease, surgery involves removing all the thyroid gland (‘total thyroidectomy’), whereas for thyroid nodules, part (‘thyroid lobectomy’) or all of the thyroid gland may be removed. Surgery is performed as an inpatient in hospital. This surgery will leave a small scar at the base of the neck near the top of the breast bone. After a total thyroidectomy, lifelong thyroid hormone replacement therapy (levothyroxine) will be needed so that your body gets enough thyroid hormone to keep working properly. This requires taking a pill containing thyroid hormone (levothyroxine; T4) every day and this is generally well tolerated and keeps the body functioning in the same way as when the thyroid gland was present.
Medications to control other symptoms
At times, other symptoms caused by hyperthyroidism require additional short-term treatment with beta-blockers. This medication is commonly provided to treat rapid heart rate and heart palpitations, trembling, heat intolerance and/or anxiety.