Treatment of hyperthyroidism

Hyperthyroidism treatment depends on the cause of the disease, the severity of the symptoms and the age of the patient. Generally, it is treated with drugs that lower the level of thyroid hormones in the blood (synthetic antithyroid drugs) and those that also lower the side effects of these hormones (beta-blockers and anxiolytics).  

Depending on the cause of the hyperthyroidism, and after 12-18 months of treatment, definitive treatment is necessary and the cause of the hyperthyroidism must be eliminated. This can involve the surgical removal of the gland or its partial destruction using radioactive iodine. 

• In Graves' disease, one third of patients go into chronic stable remission after 12-18 months of treatment and do not need iodine ablative treatment or surgery. In these cases, thyroid function should be monitored over the subsequent years to rule out thyroid failure caused by prolonged inflammation of the thyroid or recurrence of the disease.  
• In multinodular goitre, antithyroid drugs control the symptoms but cannot eliminate the nodules, so definitive treatment such as radioactive iodine or surgery must be considered. 

Other drugs that inhibit the excessive action and symptoms of thyroid hormones include: 

• Beta-blockers. This type of medication quickly blocks the action of the thyroid hormone in the body, within a few hours, reducing symptoms such as palpitations, anxiety, tremors, sweating, and nervousness, but it does not affect the levels of thyroid hormone in the blood. One of the drugs that works throughout the body is propranolol. In addition to propranolol, other drugs from the same class are also used. These have a longer action time, but act on more specific areas. For heart problems, specifically palpitations, treatments such as atenolol, metoprolol, nadolol, and bisoprolol are used.  
• Anxiolytics. In cases of insomnia and persistent anxiety despite treatment with propranolol, drugs called anxiolytics, such as lorazepam, may be prescribed to help induce sleep.  

Thyroid cells need iodine to make thyroid hormones and utilise iodine from the blood regardless of whether it is radioactive or not. 

Radioactive iodine treatment is very safe and is associated with very few complications. The goal is to reduce the size of the thyroid and progressively decrease the levels of thyroid hormone in the blood, over a short period of time. 

Iodine is administered orally (capsule) or intravenously and enters the thyroid where it is taken up by the overactive cells. Once there, it damages the thyroid cells slowly over a period of weeks or months. Any free iodine remaining in the blood is excreted in 2-3 days, in the urine, in a non-radioactive form.   

After treatment, the patient is given antithyroid drugs. A blood test is then performed to assess the response of the patient's thyroid to the treatment.  

Once the thyroid gland has been removed, depending on whether all or part of it was taken out (partial thyroidectomy, hemithyroidectomy or isthmectomy), hypothyroidism may develop and replacement therapy may be necessary.   

The treatment consists of daily doses of levothyroxine adapted to the patient's needs. Dosing and treatment management is performed in the same way as in the chronic treatment of hypothyroidism.