Treatment Options Part II (continued)

Last week, we talked about RAI, the most common treatment for Graves' Disease in the US. Today, we will continue our discussion of treatment options for hyperthyroidism.

Antithyroid drugs decrease the production of thyroid hormone by the thyroid gland. There are two drugs approved for use, propylthiouricil (PTU) and methimazole (Tapazole). They may be prescribed individually or in combination.

Treatment with antithyroid drugs may take two to ten weeks to show results and must be continued for one to two years. It results in remission of Graves' Disease about 50% of the time, however, there is a high rate of recurrence and most people end up needing thyroid hormone replacement anyway. Those with thyroid nodules must continue therapy for the long term since thyroid production almost always increases as soon as the drug is stopped. So, which has the advantage of the drugs or RAI?

RAI results in a permanent ablation (destruction) of the thyroid gland. Antithyroid drugs block the production of thyroid hormone and do not result in destruction. Antithyroid drugs can be used as interim solutions giving you time to consider alternatives without the added stress of active hyperthyroidism. Antithyroid drugs may be more effective than RAI when there is thyroid eye disease present. Taking RAI causes an initial increase in the thyroid antibodies of Graves' Disease. Antithyroid drugs do not.

Using antithyroid drugs requires multiple daily doses at regular intervals possibly for years. RAI is often a single dose, but may require multiple doses to achieve the desired effect. RAI is promoted as a final solution without remission. Both antithyroid drugs may be used in pregnancy, although PTU is thought not to cross the placenta. RAI is not recommended in pregnancy.

RAI is promoted as a quick fix, with stabilization for most of us in about six months. Antithyroid drug therapy may take a year or more. Antithyroid drugs do have potential side effects. The most common being a skin rash that may require stopping the medication. The rarer side effects include joint pain and swelling, liver inflammation and there is a 1 in 300 risk that the drug will severely decrease your immune system's ability to fight infection. It is critical that your healthcare provider be notified if you do experience fever, sore throat or infection while taking these drugs. RAI has few documented side effects.

An alternative to both RAI and antithyroid drugs is surgery. This is also a permanent fix. It is the treatment of choice for large multinodular goiters where the enlarged thyroid gland interferes with breathing or swallowing. Surgery can involve the removal of the nodule only or the complete gland. The risks include a less than two percent chance of damage to the nerves that control the vocal cords or damage to the parathyroid glands that control the calcium levels in the blood. To keep risks at this level, it is vital that you find an experienced surgeon who performs this type of operation frequently. It's not something done as an outpatient. It usually requires at least an overnight stay in the hospital to monitor for swelling and calcium levels in the blood.

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