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Treatment Options (Part II)

© Keri

In Part I, we discussed the treatment for hypothyroidism. In Part II, we will explore the treatment options for hyperthyroidism. Hyperthyroidism is a complex disease charecterised by the over-production of thyroid hormones. The treatment options focus on stopping this from happening. This eliminates the symptoms, but does not address the cause of the disease which remains unknown.

The most commonly used option for hyperthyroidism is still radioactive iodide ablation therapy also known as RAI. Early in the 1900's the thyroid was radiated by using x-rays and radium. During the 1940's, they begin giving RAI by mouth. Since then, it has become the treatment of choice in the United States. The goal is to produce a quick resolution of hyperthyroidism and lessen the potential negative effects of too much thyroid hormone. It is promoted as safe and effective without adverse reactions. It is not a choice for pregnant women and some doctors question whether it should be used in children.

The thyroid is the only gland in the body that uses iodine. When radioactive iodide is swallowed, it is concentrated in the thyroid and destroys thyroid cells. Unfortunately, there is no way to regulate the number of cells destroyed. Patients are usually left with little or no natural thyroid production. RAI typically results in hypothyroidism and a lifetime dependence on thyroid replacements.

Why is it such a popular treatment recommended by almost all sources? In the early years of this century, the only treatment for Graves' Disease was bedrest until the thyroid burned itself out. This could take as many as 15 years or more. In the meantime, people died of complications like congestive heart failure or thyroid storm. Then RAI entered the picture, it was inexpensive and easy to administer. The patient could be treated with a smaller dose than necessary for thyroid cancer and be "cured" of the symptoms of hyperthyroidism. RAI eliminates the cells that produce T3 and T4, but it does not eliminate the autoimmune antibodies present in Graves' Disease.

R131, a form of radioactive iodide released in nuclear accidents, has been linked to high rates of thyroid disease and cancer in those exposed. However, recent studies have shown no correlation between RAI and thyroid or other forms of cancer. It is considered safe. However, the effects of RAI continue over several years and those taking this treatment need to be monitored at least once a year.

RAI is swallowed in capsule or liquid form. It does not make you glow in the dark and you will not feel any effects from the iodide. Most of the iodide is concentrated in your thyroid. The rest is eliminated in the urine. It is recommended that you drink several glasses of water a day for about a week to flush the material out of your body as quickly as possible. It is unknown what effect exposure to you during this time might have on children or pregnant women. To be on the safe side, it is a good idea to limit contact with them for at least a week after the treatment.

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