When you have hyperthyroidism (known as hyperthyroidism), you will inevitably be faced with three treatment options: antithyroid drugs (ATD), 131 I and surgery. So how do we choose the treatment option that is best for us?
To answer this question, we must first have some basic understanding of hyperthyroidism and compare the advantages and disadvantages of these three treatment options to make the best choice. Hyperthyroidism is a thyrotoxicosis caused by excessive production of thyroid hormones by the thyroid gland itself. Its causes include diffuse toxic goiter (Graves’ disease, GD), nodular toxic goiter and autonomic hyperfunctioning adenoma of the thyroid gland. The prevalence of hyperthyroidism is 1%, of which more than 80% is caused by Graves’ disease. The prevalence is significantly higher in women than in men. It is Graves’ disease that we will discuss here.
First, the rationale for the three treatment options.
Anti-thyroid drugs (ATD) work by inhibiting the synthesis of thyroid hormones by the thyroid gland through drugs, thus reducing the excess thyroid hormones in the body and achieving relief and cure of hyperthyroidism. 131 I treatment, on the other hand, works by releasing rays from the radioactive 131 I that is taken up by the thyroid gland and destroys the thyroid tissue cells. The thyroid gland is the site of synthesis and storage of thyroid hormones. After the thyroid tissue is destroyed, the synthesis and secretion of thyroid hormones will be reduced, thus achieving the purpose of treatment; surgical treatment involves the direct removal of part of the thyroid tissue through surgery, so that the remaining thyroid gland will secrete less thyroid hormones and can achieve the purpose of hyperthyroidism, etc.
Second, the advantages of each of the three treatment options.
Advantages of ATD treatment.
1. ATD is the basic treatment for hyperthyroidism, with definite efficacy. Most hyperthyroid patients can be completely cured and discontinued with ATD treatment.
2. ATD treatment does not cause permanent hypothyroidism (some patients may experience hypothyroidism during the course of medication, but their nail function can be restored after reducing the dose of medication), so lifelong medication is not required.
3, part of the anti-thyroid use during pregnancy is safe, so it can be used for pregnant women.
Advantages of 131 I treatment.
1, hyperthyroidism has a history of 60 years, the method is simple, economical and rapid, and there are no reports of teratogenicity, carcinogenicity or increased side effects.
2. The cure rate of hyperthyroidism treated by this method reaches more than 85%, with a high cure rate.
Advantages of surgical treatment.
Surgical treatment is only applicable to a small number of hyperthyroid patients such as those with significant enlargement of the thyroid gland with symptoms of pressure; moderate or severe hyperthyroidism with ineffective long-term medication, or relapse when medication is stopped, or those who cannot adhere to medication; retrosternal goiter; fine needle aspiration cytology (FNA) for suspected malignancy; pregnant patients with ineffective ATD treatment or allergy, etc.
Third, the disadvantages of each of the three treatment options.
Disadvantages of ATD treatment: 1. The course of antithyroid drug (ATD) treatment is long, usually taking 1,5-2 years, and some may be longer. Some patients, especially young patients, do not know enough about the condition, poor compliance, irregular medication or unauthorized discontinuation of medication, which can easily cause recurrence of the condition and prolong the treatment time. (Therefore, if you choose ATD treatment, you must follow your doctor’s prescription!)
2. Some patients taking anti-hyperthyroidism drugs will have some adverse drug reactions, such as skin rash, itching, hair loss, liver function damage, granulocytopenia, etc., which require drug reduction or even drug discontinuation.
3. Some patients may relapse after stopping the medication, with a relapse rate of 50-60%.
Disadvantages of 131 I treatment.
1. Hypothyroidism is an unavoidable result of 131 I treatment. The incidence of hypothyroidism increases by about 5% per year, reaching 40%-70% over 10 years. Hypothyroidism caused by 131 I treatment is not reversible and requires lifelong medication to supplement thyroxine.
2. radioactive thyroiditis: occurs 7 -10 days after 131 I ingestion.
3. induced thyroid crisis: occurs mainly in patients with uncontrolled severe hyperthyroidism.
4. aggravation of active hyperthyroidism proptosis.
Disadvantages of surgical treatment.
1. Surgical removal of too little thyroid tissue may not achieve the therapeutic effect, while too much may cause permanent hypothyroidism and require lifelong medication.
2. There are certain risks associated with surgery, such as permanent hypoparathyroidism and damage to the recurrent laryngeal nerve due to surgical injury.
In conclusion, each treatment option has its own advantages and shortcomings, in general.
ATD treatment is mostly indicated for mild to moderate disease with mild to moderate enlargement of the thyroid gland; pregnant women, elderly people or those who are not suitable for surgery due to other serious diseases and those who have relapsed after surgery and are not suitable for 131 I treatment.
131 I treatment is indicated for patients with grade II or higher goiter, allergy to ATD, relapse after ATD treatment or surgery, hyperthyroidism combined with heart disease, hyperthyroidism with leukopenia, thrombocytopenia or thrombocytopenia, hyperthyroidism combined with impairment of liver, kidney and other organ functions, refusal of surgery or contraindication to surgery, and infiltrative proptosis. Surgery is indicated for patients with significant enlargement of the thyroid gland with symptoms of pressure; moderate or severe hyperthyroidism; those who have been taking medication for a long time and are ineffective, or who have relapsed after stopping medication, or who cannot adhere to medication; post-thoracic goiter; and those who are suspected of malignant changes. Currently, antithyroid drugs are preferred in China. 131 I therapy and surgery can be considered when there are obvious signs of incompatibility with ATD therapy.