Graves’ Disease Treatment

Antithyroid Medications, Radioactive Iodine, and Surgery

With proper treatment, you can minimize the effects of Graves’ disease. The goal of treatment is to control over-production of thyroid hormones (hyperthyroidism). There are three treatment options for Graves’ disease. Your doctor or endocrinologist will recommend the best treatment for you and your particular case of Graves’ disease.

Antithyroid Medications
These drugs help prevent the thyroid from producing hormones. Methimazole and propylthiouracil (PTU) are generic medications that interfere with the thyroid gland’s ability to produce hormones. While effective in relieving symptoms within a few weeks, hyperthyroidism may return after the drug is stopped.
 
Possible side effects that may mean you have an allergy to this type of medicine include skin rash, itching, and hives. Other more common side effects that are usually temporary include nausea, vomiting, heartburn, headache, joint or muscle aches, loss of taste, and a metallic taste.
 
Be sure to ask your doctor to explain serious side effects you may experience and what to do should a side effect develop.  One serious side effect with antithyroid medications is agranulocytosis, which causes you to not have enough white blood cells. That makes you more susceptible to infection, but agranulocytosis is rare. However, if you develop a fever or sore throat while on antithyroid medications, definitely call your doctor; it may be agranulocytosis.
 
If you have hyperthyroidism and become pregnant, your doctor will carefully monitor your thyroid hormone levels and adjust your medication as necessary—so that you and your baby stay healthy. In pregnant women, PTU is more commonly used than methimazole.
 
Radioactive Iodine (RAI)
Some doctors favor radioactive iodine treatment because antithyroid medications do not always provide a long-term solution to Graves’ disease-related hyperthyroidism, and surgical complications (surgery is the third treatment option—you can read more about it below) may be serious. RAI is given as a capsule or in a water-based solution. It may take months for treatment to be effective, and sometimes repeated doses are required.
 
Radioactive iodine works by destroying thyroid tissue cells, thereby reducing your thyroid hormone levels. However, there is debate as to whether a fixed dose or individually prescribed dose is best.
 
The goal of RAI treatment is to leave enough thyroid tissue for production of a healthy balance of hormones, but many—if not most—patients eventually develop hypothyroidism. Hypothyroidism (when your body doesn’t produce enough thyroid hormone) is much easier to treat, so while it may be surprising, it’s actually all right if you do become hypothyroid following RAI treatment.
 
Radioactive iodine cannot be used if you’re pregnant or if you’re planning on becoming pregnant within 6 to 9 months.
 
Surgery
Some patients may require surgery for various reasons. For example, some people cannot take or tolerate antithyroid medication or RAI, and sometimes, these treatments are not successful. Additionally, if you’re pregnant and PTU (antithyroid medication) isn’t working, the doctor may recommend surgery.
 
In other cases, a goiter may require surgical removal.
 
If surgery is the best treatment option, your doctor will explain to you why he or she is recommending it, as well as the advantages and possible complications.
 
You will be referred by your doctor to a surgeon – usually an endocrine surgeon or an ear nose and throat surgeon–to obtain a thyroidectomy (partial or total removal of the thyroid). The surgery is performed under general anesthesia. Surgery may take several hours. The surgeon removes part or the entire thyroid through a small incision made in the front of the neck. Your surgeon will discuss the details of the operation—including explaining the risks and benefits—with you. Possible complications after surgery include infection, bleeding, airway obstruction, voice hoarseness, and abnormally low blood calcium levels. Your personal surgical risks may be increased by co-existing medical problems.
 
While total removal of the thyroid effectively treats hyperthyroidism in most patients, it always results in hypothyroidism. Therefore, if you undergo a total thyroidectomy, you will need to take a thyroid replacement hormone every day. Your endocrinologist or treating physician will determine the correct dosage and monitor its effectiveness one or more times per year by simple blood work.