Hyperthyroidism is classified by etiology into Graves’ disease and autonomous functional thyroid adenoma (mainly treated by surgery). There are three types of treatment for hyperthyroidism (Graves’ disease): internal medication, radioactive iodine 131 nuclear therapy and surgery.
I. Anti-hyperthyroidism medication
1. Mild disease with mild to moderate enlargement of the thyroid gland;
2.People under 20 years of age, pregnant women, elderly people who are frail, or people with serious heart, liver and kidney diseases who are not suitable for surgery;
3. Those who are not suitable for radioactive iodine therapy after subtotal thyroidectomy;
4.Adjunctive treatment of radioactive iodine therapy;
5.Preparatory treatment before surgery.
Advantages and disadvantages of antithyroid drug therapy.
Anti-thyroid drug therapy is the most commonly used method in the treatment of hyperthyroidism. Most patients with hyperthyroidism generally prefer antithyroid drugs as the decisive treatment drug. There are both advantages and disadvantages to this therapy.
Advantages.
(1) Almost all patients have positive efficacy with these drugs.
(2) The effects of the drugs are reversible, so they do not cause permanent hypothyroidism.
(3) Serious side effects are rare, so it is safer.
(4) The treatment method is simple and easily accepted by patients.
(5) The price is relatively cheap.
Disadvantages.
(1) The duration of treatment is too long, ranging from 1 year to several years.
(2) Relapse rate after the course of treatment is high, about 50% of patients relapse within 1 year after stopping the drug. The efficacy is not as good as thyroid surgery or isotope therapy.
Antithyroid drugs commonly used are methimazole (tabazol) and propylthioxypyrimethamine. Both of these drugs are more effective and safer in controlling hyperthyroidism. Tabazol is cheaper. The main disadvantage of these two drugs is the long course of treatment, and the relapse rate can be as high as about 60% for those who have been treated for less than one year. It is necessary to take the medication for a long time.
When using anti-thyroid drugs, choose one of the following two drugs.
1.Tabazol.
Mild patients 20 to 30mg/day, moderate 30 to 40mg/day, severe 40 to 60mg/day, generally used 30mg daily in three doses.
2. Propylthiouracil.
0.1g/time, 3 times/day. In recent years, some scholars have proposed shock therapy, that is, a high dose can achieve strong inhibition of thyroid hormone synthesis. In addition, the upper drug treatment should be added with thyroid tablets after one month, 20mg per day. if drug hypothyroidism occurs in medical treatment, the dosage can be increased to 40mg per day appropriately to prevent aggravation of eye protrusion.
Side effects of antithyroid drugs for hyperthyroidism
Anti-thyroid drugs for hyperthyroidism: propylthiouracil and tabazol can cause leukopenia, which usually occurs in the first few months after the drug is used. If the drug is discontinued in time, it will recover within 1-2 weeks, therefore, the blood picture should be checked regularly during the drug use. The most serious side effects of western anti-thyroid drug therapy for hyperthyroidism are leukopenia and granulocyte deficiency, which cause a significant decrease in systemic resistance due to low granulocyte count and subsequently lead to serious systemic infections, which are extremely life-threatening. Therefore, attention should be paid to the occurrence of granulocyte deficiency during the medication, and if it is detected in time, there is a better chance of cure. Granulocyte deficiency occurs mostly during the first 3 months of drug use, but can also be seen at any time after drug use. Therefore, special vigilance should be exercised during the first 3 months of drug use.
II. Indications for radioactive iodine therapy are
1. Over 35 years of age, moderately ill, with moderate enlargement of the thyroid gland;
2. Patients with allergic or toxic reactions to antithyroid drugs that cannot be renewed, or those whose long-term treatment is ineffective or who relapse after stopping the drug;
3. Patients who are unwilling to undergo surgery, or who have contraindications to surgery, or who have relapsed after surgery.
Contraindications to radioactive iodine therapy.
1.Pregnant and lactating women;
2. Patients under 20 years of age;
3. Those with severe hepatic or renal insufficiency or active tuberculosis;
4.Severe infiltrative proptosis;
5. Those with peripheral blood leukocytes below 3000/mm or neutrophils below 1500/mm.
Complications of radioactive iodine therapy.
1. Hypothyroidism;
2.Radioactive thyroiditis;
3. Individual may induce thyroid crisis.
Thyroid surgery
Indicated for
1.Significant enlargement of the thyroid gland and compression of adjacent organs;
2.Large thyroid gland, ineffective with anti-thyroid medication or relapse after stopping medication and those who cannot or do not want to take medication;
3.Post-thoracic goiter with hyperthyroidism or nodular goiter with hyperthyroidism.
Patients with hyperthyroidism who have the following conditions are not suitable for thyroid surgery
(1) The condition is mild and the enlargement of the thyroid gland is mild, and the hyperthyroidism can often be cured by drug treatment.
(2) Malignant proptosis. Severe malignant proptosis treated with surgery may aggravate the proptosis, but generally non-severe proptosis can be treated with surgery.
(3) Adolescent hyperthyroidism is not suitable for surgery because of their immature body development, and there are relatively more recurrences after surgery.
(4) Older patients with hyperthyroidism and declining function of various organs.
(5) If hyperthyroidism recurs after surgery, it is more difficult to perform surgery again and surgical complications are likely to occur.
(6) Pregnant women with hyperthyroidism should not undergo surgery in the second trimester.