hormonal and metabolic disorders
Hyperthyroidism
Treatment of Hyperthyroidism
Treatment of cause Beta-blockers to block the effects of thyroid hormones Sometimes medications to block the production of thyroid hormones Sometimes radioactive iodine to destroy some or all of the thyroid gland Sometimes surgery to remove all or part of the thyroid Treatment of hyperthyroidism depends on the cause. In most cases, the problem causing hyperthyroidism can be cured or the symptoms can be eliminated or greatly reduced. Left untreated, however, hyperthyroidism places undue stress on the heart and many other organs. Radioactive iodinemay be given by mouth to destroy part of the thyroid gland. This is the most common treatment for hyperthyroidism. The radioactivity is mainly delivered to the thyroid gland because the thyroid gland takes up the iodine and concentrates it. Hospitalization is rarely necessary. After treatment, the person should probably not be near infants and young children for 2 to 4 days and should sleep in a separate bed separated at least 6 feet (about 2 meters) from the partner. Pregnancy should be avoided for about 6 to 12 months. People who have had radioactive iodine treatment should stay at least 6 feet away from pregnant women, infants, or small children for 6 to 23 days; the amount of time depends on the dose received. People who have had radioactive iodine treatment may set off radiation alarms at airports and sometimes other places for several weeks after treatment and, therefore, should carry a doctor’s note describing their treatment if they travel on public transportation. Some doctors try to adjust the dose of radioactive iodine to destroy only enough of the thyroid gland to bring its hormone production back to normal, without reducing thyroid function too much. Other doctors use a larger dose to completely destroy the thyroid. Most of the time, people who undergo this treatment must take Treatment for the rest of their life. Although concerns have been raised that radioactive iodine may cause cancer, an increased risk of cancer in people who have had radioactive iodine treatment has never been confirmed. Radioactive iodine is not given to pregnant or nursing women because it crosses the placenta and enters the milk and may destroy the fetus’s or breastfed infant’s thyroid gland. People who receive radioactive iodine should not go near infants and young children for 2 to 4 days. are closely monitored because these medications cross the placenta and can cause goiter or Hypothyroidism in the Newborn . Each medication is taken by mouth, beginning with high doses that are later adjusted according to blood test results. These medications can usually control thyroid function within 2 to 3 months. Larger doses of these medications may work more quickly but increase the risk of side effects. Beta-blockerssuch aspropranololormetoprololhelp control many of the symptoms of hyperthyroidism. These medications can slow a fast heart rate, reduce tremors, and control anxiety. Doctors therefore find beta-blockers particularly useful to control symptoms of hyperthyroidism until the person responds to other treatments. However, beta-blockers do not reduce excess thyroid hormone production. Therefore, other treatments are added to bring hormone production to normal levels. Iodine,given by mouth, is sometimes used to treat hyperthyroidism. It is reserved for people in whom rapid treatment is needed, such as those with thyroid storm. It may also be used to control hyperthyroidism until the person can have surgery to remove the thyroid. It is not used long-term. Surgeryto remove part or all of the thyroid gland, called thyroidectomy, is a treatment option for people with hyperthyroidism, especially for children and adolescents with Graves disease. Surgery is also an option for people who have a very large goiter as well as for those who are allergic to or who develop severe side effects from the medications used to treat hyperthyroidism or those who do not want radiation exposure. Hyperthyroidism is permanently controlled in more than 90% of people who choose this option. Hypothyroidism often occurs after surgery, and people then have to take replacement thyroid hormone for the rest of their life. Rare complications of surgery include paralysis of the vocal cords and damage to the parathyroid glands (the tiny glands behind the thyroid gland that control calcium levels in the blood). InGraves disease,additional treatment may be needed for the eye and skin symptoms. Eye symptoms may be helped by elevating the head of the bed, by applying eye drops, by sleeping with the eyelids taped shut, and, occasionally, by takingselenium,teprotumumab, or diuretics (medications that hasten fluid excretion). Double vision may be helped by using eyeglass prisms. Finally, corticosteroids taken by mouth, x-ray treatment to the orbits, or eye surgery may be needed if the eyes are severely affected. Corticosteroid creams or ointments can help relieve the itching and hardness of the abnormal skin. Often the problem disappears without treatment months or years later. 