What is Treatment of hyperthyroidism in 2020[in detail article].

Treatment of hyperthyroidism is not as simple as it sounds.It can be achieved by taking anti thyroid drugs,iodides and iodine,radioactive iodine,beta blockers and surgery.
– There are various groups of drugs used in the Treatment of hyperthyroidism.which includes;

1) Antithyroid drugs for Treatment of hyperthyroidism:

– Also known as thioamides and are used for treatment of hyperthyroidism..
– These drugs are propylthiouracil , methimazole, carbimazole.
– These drugs act by

Inhibiting the iodination of tyrosine residues in thyroglobulin
Inhibition of coupling of iodotyrosine residues to form T3 and T4.
They do not effect the levels of thyroid hormone in the blood.

– Propylthiouracil is the only drug amongst the 3 which inhibit the conversion of T4 to T3 and reduces the levels of T3 in the blood.
– Due to this effect it is preferred in thyroid storm.

Adverse effect of antithyroid drugs

Gastrointestinal intolerance
Skin rash
Allergic reactions
itching
Joint pain
Loss or graying of hair
Loss of taste
Fever
Liver failure (rarely)
If overtreatment is done it may cause hypothyroidism and may also cause goiter. And the person will present with increased size of the gland. This can be reversible on stopping the drug.

This adverse effect can be prevented by taking the proper dose of the medicine.

A very rare and serious side effect of antithyroid drugs is agranulocytosis (decreased amount of white blood cells) this is due to the suppression of bone marrow. This side effect is said to be reversible.

Red flags signs of the drugs used in Treatment of hyperthyroidism

Allergic reaction
weakness
fatigue
dull aching pain in your abdomen
decreased appetite
easy bruisability
jaundice (yellow discolouration of skin and sclera of the eye)
frequent fever
sore throat

Anti thyroid drugs used in Treatment of hyperthyroidism.

– Carbimazole is used in india more commonly.
– Propylthiouracil are used in patients developing adverse effects with carbimazole.
– The effect of these drugs may start in 1-2 weeks.
– Average time required for treatment is 1-2years but it can continue till many years.
– Antithyroid medicines are not to be used for treatment of hyperthyroidism which is caused by thyroiditis.

2) Iodines or iodides for Treatment of hyperthyroidism

– Iodine is the fastest acting inhibitor of thyroid.
– The mechanism behind this is that it interferes with the iodination of tyrosil and thyronil residues of thyroglobulin resulting in reduced T3 and T4 synthesis.
– Iodine may also act by inhibiting its own transport into the thyroid gland by interfering with sodium iodide symporter.
– However the gland recovers from this effect within few days and then “thyroid escape” occurs.
– That is more amount of thyroid hormone is released post treatment.

Uses

– It is used in preoperative preparation of thyroid for thyroid surgery.
– It makes the gland firm and less vascular and easier to operate on.
– Lugol’s iodine is given orally and is used to stop any further release of T3 and T4 from the gland and to decrease the conversion of T4 and T3.

Adverse effect of iodine:

Immediate reactions occurs in individuals who are sensitive to iodine.

– It presents in the form of
angioedema that is there occurs
swelling of eyelids
swelling of lips
fever
pain in joints
thrombocytopenia (decrease in platelet count)
lymphadenopathy
petechiaes

long term effect

– it occurs due to chronic overdose also called as IODISM.
Clinical presentation is
Inflammation of the mucous memberane
Sneezing
Rash
Excessive salivation
Runny nose
Watery eyes
Headache
Swelling of eyelids
Gastrointestinal symptoms
hypothyroidism and goiter is caused by long term use of high dose iodine
increase in the acne in

3.Radioactive iodine for Treatment of hyperthyroidism

– The radioactive iodine used for the treatment of hyperthyroid is different than the one used in the diagnosis.
– The mechanism is that the hyperactive thyroid cells absorb the radioactive iodine and it slowly destroys them.
– Radioactive iodine does not have any effect on other body tissues.
– It is given in the form of an oral solution.

Common side effects

dryness of eyes
sore throat
dryness of mouth
change in the taste
hypothyroidism (As it destroys the cells that produce thyroid hormones).

– Radioactive iodine is given as sodium salts of I¹³¹.
– It is dissolved in water and taken orally.
– The effect of radioactive iodine is due to the β particles that it emits.
– These β particles in high doses of iodine causes destruction of the thyroid follicular cells which produces the thyroid hormone.
– The response is slow and starts after 1-2weeks and the peak occurs at 2-3months.
Due to this the patients thyroid function is evaluated and if needed a repeat dose is given.

Pros and cons of this treatment

A. Pro’s

Simple treatment
Can be done on out patients basis
Affordable
No risk of scars or removal of parathyroid gland or injury to laryngeal nerves (which is seen in surgery of thyroid gland)
Can be given when surgery is contraindicated
The cure is permanent if given properly

B. Con’s

Causes hypothyroidism
Cannot be given in pregnant patient
Cannot be given in young patients

4.Beta blockers for Treatment of hyperthyroidism

– These medicines do not have any role on the levels of thyroid hormone.
– They are used to counteract the effect of thyroid hormone on the peripheral tissues.
– Beta blockers act immediately and reduces the symptoms of hyperthyroidism.
– Used to relieve the symptoms like:

Anxiety
Palpitations
Increased heart beat
Tremors/shaking
nervousness
sweating
high blood pressure

Uses:

^–Till the time the patient waits for the effect of carbimazole and propylthiouracil or Iodine
– for preoperative procedure before thyroid surgery.
– Beta blocker most commonly used is propronalol.

Surgery for Treatment of hyperthyroidism

Surgery does not play a very important role in treatment of hyperthyroidism.
Before surgery, doctor may start you on antithyroid medicines to get your thyroid hormone levels into normal range. This is done to prevent thyroid storm. A sudden rise in the thyroid hormones causing worsening of the symptoms which can occur in people with hyperthyroidism undergoing general anesthesia.
Conditions where surgery is preferred:

Pregnant women
children (due to major side effects of antithyroid medications)
very large thyroid glands
People with pressure symptoms like difficulty in swallowing, hoarseness of voice, and difficulty in breathing.

complication of thyroid surgery

architecture of surrounding tissue is distrupted
damage to nerves supplying the vocal cords.
damage to/ or accidental removal of parathyroid gland (small four glands in the neck that regulate calcium levels in the body) it can result in low calcium levels and will require calcium replacement therapy.

Surgery will be either partial lobectomy or total lobectomy.

more articles-causes of hyperthyroidism & introduction to thyroid disorders.

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