The main recognized treatments for hyperthyroidism and radioactive 131 iodine therapy.
The generally accepted treatments for hyperthyroidism in the medical community and recognized in medical textbooks are drug therapy, subtotal thyroidectomy and radioactive 131 iodine therapy, which are classified as medical, surgical and nuclear medicine, the latter two being radical treatments. Of course, hyperthyroidism also includes some auxiliary treatment methods, and Chinese medicine is also one of the auxiliary treatment methods.
1. Internal medicine: It is the application of anti-thyroid drugs, commonly known as medication, usually tabazol or propylthiouracil. Since there is no new breakthrough drug for the time being, the effect of anti-thyroid drug treatment is still unsatisfactory. Advantages: It is less likely to lead to hypothyroidism, or to temporary hypothyroidism, but can be recovered by adjusting the medication. Antithyroid drugs are suitable for most of the population. Disadvantages: The efficacy is uncertain and easily recurring, with a reported recurrence rate of 35-60%. There is also a long treatment time, you must adhere to the medication for 2-2.5 years, there are more side effects (especially on the blood system suppression, skin allergy, impact on the liver, etc.), you must check T3, T4, TSH, liver function, blood count to adjust the dose of anti-thyroid drugs, and frequent follow-up. At present, antithyroid drugs are still widely used as the basic treatment for hyperthyroidism in China.
2. Surgery: Large hospitals will be subdivided. The First Hospital of Sun Yat-sen University is in vascular thyroid surgery. The biggest advantage: the efficacy of surgical treatment is clear, the treatment period is short, and generally one surgery is done. The biggest disadvantage: hyperthyroidism surgery is dangerous, traumatic and costly. It also leaves a scar on the neck after surgery, which affects the aesthetics. Parathyroid injury leads to hypoparathyroidism and damage to the recurrent laryngeal nerve, with an incidence of 1 to 2 percent. The recurrence rate of postoperative hyperthyroidism is about 10%, and hypothyroidism occurs in 5% to 10% of patients immediately after surgery.
3. Nuclear medicine: Radioactive 131 iodine (RAI) treatment for hyperthyroidism does not require surgery, and is generally available on an outpatient basis without the need for hospitalization. The treatment can be repeated three months after one treatment. Its basic principle is that it uses the biological effect of ionizing radiation from beta rays to inhibit and destroy the hyperfunctioning thyroid tissue, reduce the synthesis and secretion of thyroid hormones, and restore the thyroid function to normal. 131 iodine treatment has no damage to other tissues in the body. The American Association of Clinical Endocrinologists (AACE) and the American Thyroid Association (ATA) recommend 131 iodine as the treatment of choice for hyperthyroidism because of its high cure rate. In elderly people with hyperthyroidism who have many comorbidities and cannot adhere to medication or tolerate surgery, 131 iodine therapy is also an ideal treatment option. The biggest advantage is that it is suitable for most people (not suitable for pregnant women). The one-time cure rate is about 80% or more, the total effective rate is more than 95%, the recurrence rate is only 1% to 4%, and the ineffectiveness rate is about 2% to 4%. There are no side effects such as allergy, white blood cell drop, liver damage, etc. The cost is low, about $1,000. The biggest disadvantage: a few patients will develop hypothyroidism (hypothyroidism), but they can take oral thyroxine tablets to maintain their thyroid function. With early detection and correction, there will be no sequelae.
The application and purchase of radioactive iodine 131 is strictly controlled by the state, and strict supervision is implemented. The personnel using it must have a strict examination and induction certificate system, and this treatment is usually arranged in large hospitals, where certain conditions must be present. Radioactive iodine (131I) solution is usually composed of an appropriate amount of mineral water plus a certain dose of radioactive 131 iodine, or radioactive iodine capsules.
There are many other treatment methods, such as Chinese herbal medicine, but unfortunately, Chinese herbal medicine is rarely effective in treating hyperthyroidism, and there are even street doctors who, in the name of Chinese herbal medicine, directly grind the anti-thyroid drug tabazol into powder and add it to Chinese herbal medicine for sale at a high price.
Status of hyperthyroidism treatment.
In China, anti-thyroid drugs are mostly used for treatment. In western developed countries, iodine 131 is mostly used for treatment. In the United States, 69% of adult hyperthyroidism patients receive iodine 131 treatment, in Europe, 22%, and in Japan, 11%. In China, after vigorous propaganda and training, iodine 131 treatment is rapidly increasing in domestic hospitals, and more and more patients are receiving iodine 131 treatment. Former US President George H.W. Bush Sr. was successfully cured of hyperthyroidism with isotope 131 iodine, and in 2004, at the age of 80, he celebrated his birthday by jumping from a height of 13,000 feet in Houston, USA with a strong body.
Radioactive 131 iodine treatment.
Since Hertz et al. reported 131I treatment for hyperthyroidism in 1942, there have been 1.5 million cases worldwide and about 300,000 cases in China, which has accumulated rich clinical experience and research results. A large number of clinical applications at home and abroad have proved that 131I treatment for hyperthyroidism has the advantages of precise efficacy, simplicity and safety, and low recurrence rate, and has been accepted by more and more clinicians and patients. In North America, 131I therapy has become the preferred treatment for hyperthyroidism. Numerous long-term studies have shown that 131I treatment does not lead to an increased risk of tumors and leukemia, and there is no increase in the incidence of thyroid malignancies; there are no adverse effects on fertility and offspring development, no increase in the rate of spontaneous abortion, and no more than natural incidence of fetal malformations.
Regarding hypothyroidism: It has been reported in the literature that some patients with hyperthyroidism develop spontaneous hypothyroidism, with an incidence of up to 16-20%, and that it is impossible to avoid hypothyroidism with any treatment. At the 26th Annual Meeting of the European Thyroid Association, after weighing the incidence of persistent hyperthyroidism, mortality rate and radioactive iodine 131 treatment, experts concluded that hypothyroidism has less impact on patients’ body compared to hyperthyroidism recurrence, and timely administration of thyroid hormone replacement therapy after the occurrence of hypothyroidism, patients can grow and reproduce normally and maintain normal quality of life without affecting patients’ quality of life and life expectancy.
It is generally considered that hypothyroidism that occurs within one year after treatment is called early onset hypothyroidism, and hypothyroidism that occurs after one year is called late onset hypothyroidism, which is mostly permanent. Early-onset hypothyroidism occurs because of the direct destruction of thyroid cells by radiation, which is related to the dose of 131I used for treatment and the sensitivity of individuals to radiation. The occurrence of early-onset hypothyroidism cannot be predicted or avoided, and even with a lower dose of 131I for hyperthyroidism, there is no guarantee that hypothyroidism will not occur, and some patients with early-onset hypothyroidism may recover on their own.
The mechanism of late onset hypothyroidism due to 131I therapy is not clear, but it may be mainly related to the patient’s autoimmune abnormality, mostly unrelated to the 131I dose. The principle of hypothyroidism management is that once diagnosed, thyroid hormone replacement therapy should be given promptly. Late onset hypothyroidism is not unique to 131I therapy, but can also occur after medical medication and surgical treatment, even without any therapeutic measures hyperthyroidism spontaneous hypothyroidism can occur in up to 16%-20%. It has also been reported in the literature that nearly half of the untreated hyperthyroid patients develop hypothyroidism after 20-30 years, mainly because of autoimmune dysfunction leading to destruction of the thyroid gland. Therefore, hypothyroidism may be one of the natural regressions in the progression of hyperthyroidism. Based on this academic view, clinicians in some parts of the world (represented by North America) treat hyperthyroidism with high doses of 131I to ensure that a high cure rate is achieved. The main purpose and advantage of using 131I therapy is to control hyperthyroidism as soon as possible, not to avoid the occurrence of hypothyroidism.
With the help of advanced instruments such as SPECT and physicians’ experience, the best 131I dose can be precisely calculated to cure hyperthyroidism and reduce the occurrence of hypothyroidism or delay the occurrence of hypothyroidism. It is also important to note that it is almost impossible to calculate the optimal 131I dose for each patient due to individual differences in innate sensitivity (which cannot be known or predicted by the physician). A nuclear medicine physician with rigorous clinical training can ensure the best possible outcome, and in clinical practice, we do achieve a majority of patients with shrinking thyroid glands who maintain normal thyroid function and do not develop hypothyroidism. However, there are a small number of patients who may develop hypothyroidism years later.
Questions about efficacy: The efficacy gradually appears 2~3 weeks after 131I treatment, manifested by the reduction of symptoms of hyperthyroidism, thyroid gland shrinkage and weight gain, and after 2~3 months, the disease is basically controlled. The thyroid gland shrinkage is the most obvious among the signs. In most patients, the symptoms of hyperthyroidism are basically relieved within 3 months, and all symptoms and signs disappear in 6 months~2 years. Return to the hospital for a review 3 months after taking 131 iodine to evaluate the effect of treatment or to decide whether to take further treatment.
Effects on fertility, on fetus and on offspring.
Patients with hyperthyroidism causing infertility or infertility and sexual dysfunction, the restoration of thyroid function to normal after 131I treatment leads to a significant improvement in fertility recovery and sexual function.
131I treatment of hyperthyroidism does not affect fertility and does not lead to genetic damage.
There is a certain threshold dose of ionizing radiation to destroy gonads leading to infertility, according to the dose threshold of radioactive infertility after acute irradiation stipulated in China’s Diagnostic Criteria for Radioactive Thyroid Diseases (GBZ107-2002) of 0.15 Gy (temporary infertility) and greater than 3.5 Gy (permanent infertility) for testes and 0.65 Gy (temporary infertility) and 2.5 to 6.0 Gy (permanent infertility) for ovaries. permanent infertility), and if a female hyperthyroid patient is treated with 370 MBq (10 mCi) 131I, the ovaries receive a radiation dose of less than 1.3 to 1.6 rad, which is comparable to the dose received from examinations such as X-ray intravenous pyelogram and barium enema. For fetuses, the effect of ionizing radiation on organ formation is minimal or nonexistent when the fetus is exposed to doses less than 5 rad before organ formation. Therefore, it can be assumed that the risk to the fetus from radiation doses less than a certain level is essentially zero, and there are no reports of increased fetal malformations due to 131I treatment of hyperthyroidism.
Treatment of proptosis: Currently, there is no effective treatment for hyperthyroidism. According to the American Thyroid Association and Society of Clinical Endocrinologists 2011 guidelines for the management of hyperthyroidism, for patients with existing or potentially developing ophthalmopathy, the guidelines recommend that hyperthyroidism must be treated as soon as possible to maintain normal thyroid function. Smoking is the most important factor in proptosis, and it is important to stop smoking and remove oneself from the smoking environment to avoid passive smoking and secondhand smoke.