Hyperthyroid Disorders

Lesson 6: Conventional Treatment Options

In this lesson students will learn about the goals of treating hyperthyroidism, and they'll learn about the pros and cons of the various treatment options.

Topics include:

Anti-thyroid drugs
Surgery
Radioiodine ablation
Strong solution of saturated potassium iodide
Ipanoic acid
Miscellaneous treatments
Considerations in Pregnancy
Topics for discussion

Introduction

Conventional treatment refers to the allopathic or medical treatments used by most physicians trained in the western hemisphere. Allopathic medicine by definition uses treatments that cause the opposite effects as the effects of the disease.

For instance, the two most aggressive conventional treatment options routinely used for hyperthyroidism, surgery and radioiodine, intentionally cause hypothyroidism as a way of reducing hyperthyroidism. One disease is replaced with another.

In this lesson, students will learn about the available conventional treatment options along with their advantages and disadvantages. This section also describes treatment recommendations in pregnancy.

For hyperthyroidism, conventional medicine aims to reduce the amount of thyroid hormone produced, whereas in alternative medicine thyroid hormone levels are reduced by eliminating the cause of the hyperthyroidism. In alternative or natural medicine, when the cause is treated, the symptoms resolve and the patient moves into remission. Remission is freedom from disease symptoms. When used correctly, anti-thyroid drugs do not cause hypothyroidism. They help the immune system heal and thereby help induce remission in a fashion similar to that of alternative medicine.

When treatment for hyperthyroidism is required, there is little agreement and considerable debate concerning which of the conventional treatment options is best. Experts do agree that while the hyperthyroidism is eliminated with these methods, none of the conventional treatment choices is ideal.

For example, in a recent survey regarding treatment for Graves' disease, 69 percent of doctors in the U.S. recommended radioiodine, whereas only 11 percent of doctors in Japan and 22 percent of European doctors recommended it. European, Japanese and African doctors, doctors that widely prefer anti-thyroid drugs, rarely if ever use radioiodine in children or women of child-bearing age, whereas in the U.S. radioiodine is routinely used.

The ultimate goal of conventional treatment for hyperthyroidism is to reduce thyroid hormone levels in the blood in an effort to stop the signs and symptoms caused by hyperthyroidism. This is primarily accomplished in three ways:

Medications known as anti-thyroid drugs or ATDs Thyroidectomy Surgery, either total or partial Radioiodine Ablation

The latter two methods limit the amount of hormone that can be produced by removing or destroying thyroid tissue. ATDs inhibit iodine absorption in the gut, limiting the amount of iodine available to produce thyroid hormone. Thyroid hormone is primarily composed of iodine and the amino acid tyrosine. ATDs also help the immune system heal allowing the body to achieve remission. In this sense ATDs address both the symptoms and the underlying cause of disease.

In addition to these three methods, there are several substances such as sodium ipodate that have properties similar to those of ATDs that are sometimes used. And while strong iodine solution was once the only medical treatment available, it's now primarily used by naturopath practitioners.

In the United States, surgery, usually partial thyroidectomy, is primarily used in children, in people with large goiters who do not respond well to ATDs, and in people who have potentially malignant nodules. Surgery is not generally recommended as a first choice in adults because it is the most invasive procedure and considerably more expensive than the other therapies.

Experts recommend that patients be given a complete explanation of their illness and the types of treatment that are available along with a list of potential side effects. The goal is to involve the patient as a partner in the decision-making process. Both short-term and long-term effects of treatment should be discussed. Because many thyroid disorders resolve on their own and benefit from a low-iodine diet, the College of American Pathologists recommends a low-iodine diet as a first line approach to reduce hyperthyroidism and the size of nodules in patients with nodular goiter.

The Harvard endocrinologist, P. Reed Larsen, recommends that patients with hyperthyroidism start out with ATDs while their disease course is evaluated. During this time further tests can be run to confirm the exact cause of hyperthyroidism and its natural disease course can be ascertained. Doctor Larsen states that aggressive treatment should not be rushed into because the results are permanent.