Treatment of Patients with Overactive Thyroid Glands

QUESTION: Could you discuss the treatment of patients with overactive thyroid
glands?
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ANSWER: Your thyroid is a small gland in the neck that fits around the
esophagus and windpipe. It creates several hormones that are important in
regulating the body's metabolism. Underactivity or overactivity of the
thyroid means that the levels of these hormones are either too high or too low
and metabolism is thrown off.
Symptoms of hyperthyroidism, or thyroid overactivity, include sweating,
palpitations, insomnia, hyperactivity, tremor, and anxiety.
Hyperthyroidism is diagnosed with tests that evaluate the blood levels of
both hormones that the thyroid creates and hormones that control the thyroid.
Your physician may also run a 24-hour radioiodine uptake test, that finds out
how much iodine your thyroid is using.
There are several causes for an overactive thyroid. It is often
associated with Graves' disease or toxic diffuse goiter. Too little iodine in
the diet is another possible cause of hyperthyroidism, as is infections or
inflammations of the thyroid gland. In some cases, hyperthyroidism is treated
by treating the cause of the overactivity, rather than the gland itself.
Possible treatments for hyperthyroidism include antithyroid drugs,
radioactive iodine, and surgery. Antithyroid drugs halt or reduce thyroid
activity by interrupting a step in hormone synthesis in the gland. Because
the thyroid can store a large amount of already made hormone, it takes 6 to 8
weeks of drug therapy before blood hormone levels are reduced to normal.
After several months, some patients may go into remission and need no drugs
for a time, but relapses frequently occur. Some patients are given potassium
iodine supplements in addition to antithyroid drugs.
Radioactive iodine inhibits overactivity because the thyroid takes up the
iodine. This is a safe therapy for most patients, but cannot be used for
either children or pregnant women. After radioactive iodine therapy, the
patient usually has an underactive thyroid--hypothyroidism--and must take
iodine or thyroid supplements.
Surgical removal of the thyroid is rarely used now and only for patients
who cannot take antithyroid drugs or radioactive iodine. As with radioactive
iodine, hypothyroidism often occurs after surgery.
Hyperthyroidism symptoms can be treated with drugs called beta-blockers
that are more commonly used to treat heart conditions and hypertension