Treatment of Graves' Disease

The aim of treatment is to reduce the production of thyroid hormones and to block the effect of the hormones on the body.

Updated: June 16, 2022

The aim of treatment is to reduce the production of thyroid hormones and to block the effect of the hormones on the body.

Treatment of Graves' Disease:

Treatment options includes:

Radioactive iodine therapy:

You are provided with radioactive iodine, or radioiodine to take it by mouth in this therapy. Since the thyroid gland needs iodine to produce hormones, the radioiodine goes into the thyroid cells and the overactive thyroid cells will be destroyed by the radioactivity over time. As a result your thyroid gland will shrink and gradually the symptoms will reduce. This may take over several weeks to several months to be effective.
One of the side effects of this therapy is development of new or worsened symptoms of Graves' ophthalmopathy which is usually mild and temporary. But, if you already have moderate to severe eye problems, this therapy is not recommended. Other side effects may include tenderness in the neck and a temporary increase in thyroid hormones. Radioiodine therapy is not suitable for treating pregnant women or women who are breast-feeding.
You will likely need supplements of thyroid hormone to meet the requirement of your body as this treatment causes thyroid activity to decline.

Anti-thyroid medications:

Anti-thyroid medications works by interfering with the use of iodine to produce hormones by thyroid. These prescription medications include propylthiouracil and methimazole (Tapazole). Methimazole is considered the first choice as there is a risk of liver disease with propylthiouracil. Hyperthyroidism may worsen after a period of time by using these medication. However taking the drug for longer than a year, may result in better long-term results. Anti-thyroid drugs may also be used before or after radioiodine therapy as a supplemental treatment. Rash, joint pain, liver failure or a decrease in disease-fighting white blood cells are the most common side effects of both drugs. For treatment of pregnant women in the first trimester, methimazole is not used  because of the slight risk of birth defects. Therefore, propylthiouracil is the preferred anti-thyroid drug during the first trimester for pregnant women. After the first trimester, the use of methimazole is generally resumed. Propylthiouracil is no longer prescribed after first trimester of pregnancy.

Beta blockers:

These medications which include propranolol, metoprolo, atenolol and nadolol works by blocking the effect of hormones on the body. Symptoms of irregular heartbeats, tremors, anxiety or irritability, heat intolerance, sweating, diarrhea, and muscle weakness can be relieved by these medications. As the drugs may trigger an asthma attack, beta blockers are not prescribed for people with asthma. These drugs may also complicate management of diabetes.

Surgery:

Thyroidectomy or subtotal thyroidectomy in which all or part of your thyroid is removed respectively, is an option for the treatment of Graves' disease. You will likely need supplements of thyroid hormone to meet the requirement of your body after the surgery. Damage to the nerve that controls your vocal cords and parathyroid glands which are the tiny glands located adjacent to your thyroid gland are the risks of this surgery. Parathyroid glands produces a hormone that controls the level of calcium in your blood. But these complications are rare in thyroid surgery under the care of a experienced surgeon.

Treatment of Graves' ophthalmopathy:

Graves' ophthalmopathy may be managed by using over-the-counter artificial tears during the day and lubricating gels at night if you have mild symptoms. But if your symptoms are more severe, the following treatments may be recommended:

Corticosteroids:

Corticosteroids, such as prednisone may shrink the swelling behind your eyeballs. Fluid retention, weight gain, elevated blood sugar levels, increased blood pressure and mood swings are some of the common side effects of this medication.

Prisms:

Prisms in your glasses may correct your double vision which can be caused by either because of Graves' disease or as a side effect of surgery for Graves' disease.

Orbital decompression surgery:

The bone between your eye socket or orbit and your sinuses is removed in this surgery which will provide your eyes space to move back to their original position. Usually this treatment is recommended, if there is possibility of loss of vision due to pressure on the optic nerve. Possible complications include double vision.

Orbital radiotherapy:

Orbital radiotherapy uses targeted X-rays to destroy some of the tissue behind your eyes. This procedure continues for several days to be effective. Orbital radiotherapy is recommended if your eye problems are worsening and prescription corticosteroids alone are not effective or well-tolerated.
Symptoms of Graves' ophthalmopathy may even get worse for three to six months with treatment for Graves' disease. However, the signs and symptoms of Graves' ophthalmopathy usually stabilize for a year or so and then begin to get better, often on their own.


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