What treatments are available for hyperthyroidism?

  With the accumulation of experience in medical practice, more and more studies have found that different treatment methods are appropriate for patients with different etiologies and conditions of hyperthyroidism, and individualization and optimization of treatment plans have gradually become the most important aspects of the treatment of hyperthyroidism today. The following is a brief introduction of the conventional effective treatment methods: 1. Surgery: It is effective in the near future, but the number of hyperthyroidism patients choosing this treatment method is decreasing year by year due to complications such as trauma, scar formation and hoarseness caused by nerve damage. According to the authorities, only about 5% of hyperthyroidism patients worldwide choose surgery.  It is mainly used for the following patients with hyperthyroidism: (1) extremely enlarged thyroid gland with pressure symptoms; (2) patients with hyperthyroidism who are suspected to have malignant lesions; (3) women who cannot adhere to long-term medication and are not suitable for iodine-131 treatment; (4) women who have multiple relapses in their medication history and are in a hurry to get pregnant in the short term.  (2) Common medications: Methimazole (Tabazol, Sage, Methotrexate, etc.), propylthioxypyrimethamine and other thyroid suppressant agents are commonly used. These drugs can lower T3 and T4 more quickly, but the disadvantages are long medication time, low cure rate (only about 30-50%), and obvious side effects such as white blood cell decline and drug-related liver damage.  This method is suitable for the following patients: (1) mild disease with mild enlargement of the thyroid gland; (2) under 20 years of age; (3) hyperthyroidism during pregnancy or lactation; (4) adjuvant treatment before and after iodine-131 therapy; (5) preoperative preparation for hyperthyroidism.  3. Iodine-131 ablation: After more than 70 years of experience worldwide, iodine-131 ablation has become more and more popular among clinicians and patients. Compared with the two aforementioned treatments, Iodine-131 ablation is a painless “endo-thyroidectomy” with significant advantages such as simplicity and safety, good efficacy, low recurrence rate, few complications and low cost. In the United States, it is the preferred treatment for hyperthyroidism by 70% of internists and hyperthyroid patients. Former U.S. President George W. Bush and former Japanese Prime Minister Kakuei Tanaka also chose to use Iodine-131 ablation for their hyperthyroidism and received good results. In general, the effect of iodine-131 gradually appears in 2-3 weeks after taking it, and the symptoms gradually improve and the thyroid gland shrinks significantly (with cosmetic effect) in 1-3 months, and all the symptoms disappear in 3-6 months. Therefore, after this method of treatment, patients are often restored to health without realizing it. When summarizing the efficacy of Iodine-131 ablation, the world’s authoritative medical text “Hitchcock Internal Medicine” clearly states: “Iodine-131 ablation is the most effective and cost-effective method among current hyperthyroidism treatments and is the preferred treatment for adult hyperthyroidism”. The American Journal of Medicine, the most influential medical journal in the world, has made an objective evaluation of its safety: “Iodine-131 ablation has become the most commonly used method for the treatment of hyperthyroidism in the United States; it is not carcinogenic, does not reduce the fertility of patients, and has no adverse effects on future generations or the surrounding population. According to the latest version of the Chinese Society of Endocrinology Guidelines for the Treatment of Thyroid Diseases, this treatment is available to all patients with hyperthyroidism, except for pregnant and lactating patients.  This treatment is particularly suitable for the following 9 categories of patients with hyperthyroidism: (1) age 20 years or older with goiter of grade II or higher; (2) contraindications such as failure of antithyroid medication, allergy or leukopenia; (3) recurrence of hyperthyroidism after surgery; (4) hyperthyroid heart disease or heart disease with other causes; (5) hyperthyroidism with leukopenia and/or thrombocytopenia; (6) hyperthyroidism in old age; (7) hyperthyroidism with diabetes mellitus (7) hyperthyroidism with diabetes mellitus; (8) toxic multinodular goiter; (9) functional autonomic thyroid nodules combined with hyperthyroidism.  The incidence of hypothyroidism is about 15% in the early stage (within 1 year) of iodine-131 ablation treatment for hyperthyroidism, and increases by 7-10% each year thereafter.