Currently, there are three main types of treatment for hyperthyroidism:
1. Anti-thyroid drugs (ATD):
In China, anti-thyroid drugs are still the most commonly chosen treatment. The main drugs are methimazole (MMI) and propylthiouracil (PTU). Although the remission rate of ATD treatment can reach 60%-70% and antithyroid drug treatment is safer, the course of treatment is long and patients often have difficulty in adhering to it. In addition, even if patients with hyperthyroidism take the medication according to the course, 25%-30% of them will still have a relapse of the disease.
Indications.
(1) Patients with mild to moderate enlargement of the thyroid gland;
(2) Adolescents and children under 0 years of age;
(3) Heart patients, protruding eyes and pregnant women;
(4) Patients with subtotal thyroidectomy, postoperative recurrence and inappropriate for radioactive 131 iodine treatment.
In general, the treatment is MMI 30-45mg/d or PTU 300-450mg/d in 3 oral doses, with a long half-life of MMI, which can be taken as a single dose every day. When the symptoms disappear and the blood level of thyroid hormone is close to normal, the dosage is gradually reduced. The dose is reduced once every 2 to 4 weeks, with MMI reduced by 5 to 10 mg and PTU by 50 to 100 mg each time, and the treatment is maintained at the lowest effective dose, with MMI about 5 to 10 mg/d and PTU about 50 to l00 mg/d. The total course of treatment is generally 1 to 1.5 years. In recent years, the method of taking small doses of MMI, i.e. MMll0mg~3Omg/d, has the same therapeutic effect as 40m/d.
The relapse rate is low if the thyroid gland is obviously shrunken and TSAb negative at the time of drug discontinuation; the relapse rate is high if the thyroid gland is still enlarged or TsAb positive at the time of drug discontinuation, and the relapse mostly occurs within 3-6 months after drug discontinuation. If hypothyroidism or an enlarged thyroid gland occurs during treatment, L-T4 or thyroid tablets may be added as appropriate.
Anti-thyroid drugs are slow acting and cannot rapidly control the various symptoms of hyperthyroidism, especially the manifestation of increased sympathetic excitability. Therefore,in the early stage of treatment, β-blocker “Thaumaturgic” can be applied in combination, 10-20mg, 2-3 times a day, to improve symptoms such as palpitations, tachycardia, excessive sweating, tremor and mental tension.
The side effects of antithyroid drugs are rash, itchy skin, leukopenia, granulocytopenia, toxic liver disease and vasculitis. Patients should pay attention to the presence of fever, sore throat, myalgia and infection symptoms during the medication period, and should stop the medication as soon as these manifestations are found; white blood cells should be checked regularly. General drug rash can be treated with antihistamines, if necessary, stop the drug or switch to other anti-thyroid drugs.
2. Radioactive iodine-131 treatment.
Radioactive iodine therapy is the treatment of choice for hyperthyroidism in the United States. This method is safe, simple, inexpensive and highly effective. The total efficiency is 95%, the clinical cure rate is over 85%, and the recurrence rate is less than 1%.
The thyroid gland is highly concentrated in 131 iodine. When iodine 131 decays, it emits beta and gamma rays (99% of which are beta rays), and the range of beta rays in the tissue is only 2mm, so the ionizing effect is limited to the local thyroid gland and does not affect the neighboring tissues. Therefore, the ionizing effect is limited to the local thyroid gland and does not affect the adjacent tissues. Thus, some of the thyroid epithelial tissues can be destroyed, thus reducing the function of the thyroid gland for the purpose of treatment.
Contraindications:
Pregnant and lactating women.
The main complication of I-131 treatment for hyperthyroidism is hypothyroidism. Hypothyroidism is an unavoidable consequence of I-131 treatment for hyperthyroidism. The choice of I-131 treatment is mainly a matter of weighing the pros and cons of the consequences of hyperthyroidism and hypothyroidism. After the occurrence of hypothyroidism, L-T4 replacement therapy can be used to maintain normal thyroid function, and patients can live, work and study normally, and women of childbearing age can have pregnancy and delivery. Due to the high incidence of complications of hypothyroidism, informed and signed consent of the patient is required before treatment with I-131. The doctor should also inform the patient about the precautions for radiation protection after I-131 treatment.
3. Surgery:
There is still a tendency for hyperthyroidism to recur if the amount of thyroid gland is retained; and for subclinical or clinical hypothyroidism and thyroid nodule-like hyperplasia if the amount of thyroid gland is retained is low. Postoperative L-T4 supplementation can prevent recurrence of hyperthyroidism and treat hypothyroidism and suppress the occurrence of nodular goiter. Minimally invasive surgery can reduce the aesthetic impact of thyroid surgery scars.
Indications for surgical treatment are.
(1) Moderate or severe hyperthyroidism where long-term drug therapy is ineffective or ineffective.
(2) Relapse after discontinuation of medication with a large thyroid gland.
(3) Nodular goiter with hyperthyroidism.
(4) Compression on surrounding organs or retrosternal goiter.
(5) Suspected coexistence with thyroid cancer.
(6) In cases of poorly controlled hyperthyroidism during pregnancy with medication, surgical treatment can be performed in the middle of pregnancy (13th-24th weeks).
In recent years, with the increased use of I-131 therapy, fewer people have been treated surgically than before. Surgical treatment must be performed when the patient’s hyperthyroidism is under control.
When treating hyperthyroidism, the ability to choose the right treatment is crucial to the prognosis. When choosing a treatment for hyperthyroidism, in addition to considering the advantages and disadvantages of each treatment method, you should also choose a treatment plan that is appropriate for each patient’s individual situation, including age, disease duration and condition. The best treatment is the one that is suitable. For severe hyperthyroidism, elderly hyperthyroidism, especially those with cardiovascular complications, anti-thyroid drugs are often used first to normalize hyperthyroidism, and then I-131 therapy or surgery is used. The goal is to reduce thyroid crisis or exacerbation of hyperthyroid symptoms. Patients with thyroid nodules or suspected cancerous tumors may prefer surgery; for relapsed patients, whether they have failed initial drug treatment or relapsed after surgery, radioactive iodine therapy is appropriate to reduce the risk of another recurrence of hyperthyroidism. In addition, treatment of hyperthyroidism patients also includes attention to rest and adequate calories and nutrition, such as sugar, protein and B vitamins. Foods and medications high in iodine should be avoided during treatment. Prominent eyes should be protected from serious eye complications, etc.