September 08, 2008

Overactive Thyroid: benefits & risks of treatment options. Which is better mode of treatment?

What is Overactive Thyroid?

Hyperthyroidism (also known an overactive thyroid) occurs when the thyroid gland produces excessive thyroid hormones. This causes many of the body's functions to speed up. About 2 in 100 women, and 2 in 1000 men, develop hyperthyroidism at some stage of their life.

Treatment of Overactive Thyroid

Three forms of treatment are available for hyperthyroidism. Each of them have their own advantages and limitations and physicians prefer one to another due to reasons of simplicity, cost and availability and also on the severity of hyperthyroidism, existing illnesses and the age of patient. Each of the possible treatments for an overactive thyroid have some advantages and some disadvantages. In general, all three treatments are highly effective and associated with a low risk of side effects.

Drug Therapy

Drug therapy includes the use of beta-blocking agents and antithyroid drugs.

Antithyroid Drugs (ATD)

Most patients with hyperthyroidism are given antithyroid drugs as initial therapy. The drugs commonly used are methimazole, carbimazole and propylthiouracil. There are 2 main antithyroid drugs available for use in the United States: methimazole (Tapazole) and propylthiouracil (PTU). They interfere with the ability of the thyroid gland to synthesize its hormones and are usually given in high doses until the thyroid gland functions normally (becomes euthyroid). This can take one to two months. PTU is preferred in pregnant hyperthyroid patients.

The dose and duration of ATD is based on the age and severity of the hyperactivity and cause of hyperthyroidism.

Indications and Benefits of ATD:

availability and simplicity
ATD drugs work well to control the overactive thyroid, bring prompt control of hyperthyroidism, and do not cause permanent damage to the thyroid gland
may be used for long-term treatment of Graves' disease. In about 20% to 30% of patients with Graves’disease, treatment with antithyroid drugs for a period of 12 to 18 months will result in prolonged remission of the disease.
PTU is preferred choice in pregnant women with overactive thyroid
preferred treatment by many endocrinologists for children and for adults who refuse radioactive iodine
pretreatment of older and cardiac patients before radioactive iodine or surgery
both medications (methimazole and PTU) considered safe for use while breastfeeding

Disadvantages, Risks and Possible Side Effects:

High relapse rate (relapse is more likely in smokers, patients with large goiters, and patients with positive thyroid-stimulating antibody levels at the end of therapy). When treatment is stopped, blood tests are performed to see if the hyperthyroid condition returns, which will occur in about half of all patients.
PTU can cause elevated liver enzymes (30%), and immunoallergic hepatitis (0.1-0.2%)
Methimazole can cause rare cholestasis and rare congenital abnormalities
Minor side effects (less than 5%) include rash, fever, gastrointestinal effects, and arthralgia
Rare side effect is called "agranulocytosis". This is a condition in which the white blood cells, which fight infection, disappear from the body. This could be a serious problem if an infection developed while those white blood cells were low. Fortunately, there is usually a warning when you get agranulocytosis - a fever and a sore throat. Patients on antithyroid drugs who develop a fever and a sore throat should stop the pills and call right away to get a blood test. If the blood test shows agranulocytosis, patients must remain off the antithyroid drugs. The white blood cells usually return to normal within one to two weeks.

Beta-blocker Medicines

There are medications available to immediately treat the symptoms caused by excessive thyroid hormones, such as a rapid heart rate. One of the main classes of drugs used to treat these symptoms is the beta-blockers (e.g., Inderal, Tenormin, Lopressor). Some people take a beta-blocker medicine for a few weeks whilst the level of thyroxine is reduced gradually by one of the available treatments. Beta-blockers can block some of the effects of a high level of thyroxine. In particular they help to reduce the symptoms of tremor, palpitations, sweating, agitation, and anxiety.

Indications and Benefits:

Prompt relief of the adrenergic symptoms of hyperthyroidism such as tremor, palpitations, heat intolerance, and nervousness.
Treatment of choice for thyroiditis
First line therapy before surgery, radioactive iodine, and antithyroid drugs
Short term therapy in pregnancy

Disadvantages, Risks and Possible Side Effects:

Must be used with caution in older patients and in patients with pre-existing heart disease, chronic obstructive pulmonary disease, or asthma.

Radioactive Iodine (RAI)

The thyroid cells are the only cells in the body that are able to absorb iodine. By giving radioactive iodine, cells in the thyroid are damaged or destroyed and are unable to produce further thyroid hormone. Radioiodine therapy involves taking a drink, or swallowing a capsule, which contains radioactive iodine. The dose of radioactivity to the rest of the body is very low and is not dangerous. There has been a misconception in the minds of general public and most of the physicians that radioiodine therapy is very harmful. However, since the dose administered is very small and no significant side effects are documented many feel that this cheapest and simplest and probably once for all treatment of hyperthyroidism is under utilized.

Indications and Benefits:

Inexpensive, highly effective, easy to administer, and safe
High cure rates with single-dose treatment (80%)
Treatment of choice for Graves' disease in the United States, multinodular goiter, toxic nodules in patients older than 40 years, and relapses from antithyroid drugs

Disadvantages, Risks and Possible Side Effects:

Delayed control of symptoms
Posttreatment hypothyroidism in majority of patients with Graves' disease regardless of dosage (82% after 25 years)
Contraindicated in patients who are pregnant or breastfeeding
Can cause transient neck soreness, flushing, and decreased taste
Radiation thyroiditis in 1% of patients
May exacerbate Graves' ophthalmopathy
May require pretreatment with antithyroid drugs in older or cardiac patients
Treatment of hyperthyroidism in children remains controversial
Reluctance to use in women of childbearing years

Surgery (thyroidectomy)

In a situation where radioiodine is not available and the patient is not responding to ATD patients are subjected to a surgery. Surgery (thyroidectomy) involves removing part of the thyroid gland. It may be a good option if you have a large goitre (thyroid swelling) which is causing problems in the neck. If too much of the thyroid is removed it is not usually a problem as you can take thyroxine tablets to keep the thyroxine level normal. It is usually a safe operation, although as with all operations there is a small risk. This mode of treatment requires 5-10 days of hospitalization.

Indications and Benefits:

Treatment of choice for people:
- with very large goiters
- who cannot tolerate antithyroid medicine or fail antithyroid drugs
- who refuse radioactive iodine treatment
- who have opthalmopathy (staring/bulging eyes)
- young women and contemplating pregnancy
- with severe disease who could not tolerate recurrence
May be done for cosmetic reasons

Disadvantages, Risks and Possible Side Effects:

Higher morbidity and cost than radioactive iodine
Risk of hypothyroidism (25%) or hyperthyroid relapse (8%)
Temporary or permanent hypoparathyroidism or laryngeal paralysis (less than 1%)
Requires patient to be euthyroid preoperatively with antithyroid drugs or iodides to avoid thyrotoxic crisis

Natural Herbal Remedies For Overactive Thyroid

ThyroSoothe is a natural herbal remedies for thyroid. It is formulated for overactive thyroid. This remedy naturally decrease levels of T4 and TSH and inhibit the binding of antibodies to the thyroid.

Thyroid Assist is a natural remedy for thyroid treatmen, t effectively helping to heal hypothyroidism and hypothyroid symptoms. It can help to restore deficient iodine levels, while also stimulating the thyroid to produce crucial thyroid hormones, thereby treating hypothyroidism.

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