Treatment of Graves’ disease

Graves’ disease is a toxic form of hyperthyroidism that may require immediate treatment. Treatment includes antithyroid drugs or medications, radiation therapy with radioactive iodine and surgery.

Hyperthyroidism due to Graves’ disease is, in general, easily controlled and safely treated and treatment is almost always successful. However, with most therapies for hyperthyroidism there is an eventual development of hypothyroidism or underactive thyroid gland. This may occur sooner with surgery or radioactive iodine use. 1-6

Treatment of Graves’ disease is outlined as follows .

Radioiodine therapy

Radioiodine therapy is the most commonly used therapy in Graves’ disease treatment in the United States. The patient is prescribed radioactive iodine-131 as pills to be taken by mouth.

Because the thyroid gland collects iodine to make thyroid hormone, this radioactive I is also taken up by the gland selectively. The I131 is a stronger radioactive Iodine than one used for thyroid scans. It serves to gradually destroy the cells that make up the thyroid gland and leaves other tissues unaffected.

High doses of the I131 can shut down that thyroid gland completely. This is chosen by some physicians. Some, however, prefer to use smaller doses to bring hormone production into the normal range.

This therapy may be needed more than once. The results of the therapy often takes time and appear in a few weeks and sometimes even after several months.

Some studies have suggested that Graves’ ophthalmopathy is worsened by I131. These patients may need consultation to understand the risks. They may need additional steroid drugs to reduce these adverse effects.

I 131 is not known to cause birth defects or infertility but is generally contraindicated and avoided in pregnant women as the fetal thyroid gland may be at risk of damage. It is also avoided in breastfeeding women. Radioactive iodine can be harmful to the fetus’ thyroid, and it can be passed from mother to child in breast milk.

Over time, this therapy may lead to an underactive thyroid gland or hypothyroidism. People with hypothyroidism must take synthetic thyroid hormone as replacement therapy.

Medications for Graves’ disease

Medications used for Graves’ disease include Beta blockers and antithyroid medications.

Beta blockers are drugs used in treatment of high blood pressure. These drugs as such do not reduce the thyroid hormone production but may relieve symptoms of anxiety; palpitations and high heart rate. They also relieve symptoms of shakiness and tremors.

Antithyroid drugs include Carbimazole, methimazole and propylthiouracil. These act on the thyroid gland and prevent its use and uptake of iodine to make thyroid hormones. These drugs usually provide temporary relief and do not produce permanent results. In addition, a constant monitoring of hormone levels is required.

These drugs are most suitable in pre-treatment of patients older than 60, pregnant women, breastfeeding women or those who have other health problems before planning on radioiodine therapy.

Antithyropid drugs may also be used after radioiodine therapy.

Pregnant women can take only Propylthiouracil. They cannot take methimazole as it can cross the placental barrier and damage the fetal thyroid gland.

Women who are breastfeeding should take the smallest dose necessary of either drug. The common side effects of antithyroid drugs are allergic reactions, rashes and itching, liver damage, decrease in the number of white blood cells, propensity to get infections etc.

Thyroid Surgery for Graves’ disease

Thyroid surgery is the least commonly used option in treating Graves’ disease. However, this option may be chosen for patients who are not suitable for antithyroid medications and radioactive iodine.

This includes pregnant women and people in whom thyroid cancer is suspected, or those who fail other forms of treatment. Graves’ disease does not lead to thyroid cancer.

For the surgery, part or whole of the thyroid gland is removed. Some doctors prefer to remove the whole thyroid gland to prevent recurrence of hyperthyroidism. However, this may lead to hypothyroidism and the patient needs to take thyroxine replacement therapy in form of thyroxine pills lifelong.

In addition, surgery entails risks like bleeding injury to major nerves and blood vessels of the neck, and injury to the parathyroid glands etc. The parathyroid glands are located very close to the thyroid gland. They help control the levels of calcium in blood.

Treatment for eye problems with Graves’ disease

Eye problems with Graves’ disease may not be relieved with the above therapy. These may have to be treated separately. Eye drops are prescribed to relieve dry and irritated eyes.

Sometimes steroid drugs like Prednisone are prescribed to prevent immune response and provide relief.

People with blurring vision, double vision and other vision problems may need special lenses and glasses.

Patients are advised to sleep with the head elevated to reduce eyelid swelling. Those who are unable to fully close their eyelids special taping may be used at night to prevent dry eyes.
 

Sources

1. www.thyroid.org/.../Graves_brochure.pdf
2. http://www.endocrine.niddk.nih.gov/pubs/graves/graves.pdf
3. http://www.patient.co.uk/doctor/Graves'-Disease.htm
4. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001398/
5. www.bbc.co.uk/health/physical_health/conditions/gravesdisease.shtml
6. http://www.royalberkshire.nhs.uk/pdf/Graves_jan11.pdf