Hyperthyroidism is an abbreviation for hyperthyroidism. Hyperthyroidism is a condition characterized by an increase in basal metabolism and increased sympathetic excitability due to high levels of thyroid hormones in the body. Typical hyperthyroidism is characterized by an increased appetite, protruding eyes, talkativeness, insomnia, rapid heart rate, and fatigue. Hyperthyroidism can cause damage to the heart, liver, eyes, and other organs or lead to many complications. Therefore, patients with hyperthyroidism must be treated actively. At present, there are three main treatment methods for hyperthyroidism, namely, medication, radioactive iodine 131 and surgery. The specific treatment method for hyperthyroidism depends on the patient’s age, thyroid gland size, hyperthyroidism, local medical conditions and the patient’s wishes.
I. Drug treatment for hyperthyroidism
The advantages of drug treatment for hyperthyroidism are safety, convenience, small side effects and generally no permanent hypothyroidism; the disadvantage is that it takes a long time to take the drug and the condition is prone to relapse after stopping (40%-50% relapse). The following patients are suitable for drug treatment:
1, mild clinical symptoms, mild to moderate enlargement of the thyroid gland;
2. Adolescents under 20 years of age, pregnant women or the elderly and infirm;
3.Patients who have relapsed after thyroid surgery and are not eligible for isotope therapy.
The commonly used antithyroid drugs are methimazole (Tabazol/Sage) and propylthiouracil, which can be divided into the initial treatment phase, the reduction phase and the maintenance phase because of the long duration of treatment required for hyperthyroidism.
1. Initial treatment phase: 20-30 mg of methimazole or 200-300 mg of propylthiouracil daily. Patients usually see the effect after 2-4 weeks of treatment. This phase usually takes 2-3 months. If the patient’s symptoms do not decrease after 3 months of treatment, other factors should be considered, such as irregular medication, iodine-containing drugs (kombucha, seaweed, acetaminophen, etc.), consumption of foods high in iodine (kelp, nori, etc.), mental stress, excessive fatigue, etc.
2.Dose reduction stage: When the patient’s symptoms are reduced or disappeared, and the T3 and T4 in blood are close to normal, the dose of medication can be gradually reduced under the guidance of the doctor, and should not be stopped without authorization.
3. Maintenance phase: After the symptoms disappear or the disease stabilizes, the patient still needs to take small doses of propylthiouracil (25-100 mg) or methimazole (2.5-10 mg) within 1-2 years. Only in this way can we effectively prevent the recurrence of the disease, the course of treatment is not enough, premature discontinuation of drugs prone to relapse.
Isotope iodine 131 treatment for hyperthyroidism
Isotope iodine 131 can treat hyperthyroidism by destroying the thyroid follicles and reducing the release of thyroid hormones. The advantages of isotope treatment for hyperthyroidism are good efficacy, simple treatment, fast and convenient, but hypothyroidism may occur in some patients, however, hypothyroidism is relatively simple to treat and the medication has no side effects. Medical science has proven. Taking isotope treatment will not affect fertility and will not lead to an increase in the occurrence of tumors, so unmarried women who have not had children can use isotope treatment. Patients who have been treated with medication for hyperthyroidism should stop taking the medication for 3-7 days before isotope therapy.
The following patients are suitable for radioactive iodine treatment:
1. Patients over 18 years of age with moderate hyperthyroidism;
2. Patients who are allergic to antithyroid drugs;
3. Patients who have not been treated with medication or who have relapsed after stopping medication;
4.Patients with recurrence of the disease after surgical treatment;
5, combined with heart, liver, kidney and other organ lesions, not suitable for surgery or drug treatment;
6.Some high-functioning nodular hyperthyroidism.
Caution: The chance of hypothyroidism is 4.6%-5.4% after 1 year of radioactive iodine treatment, and the incidence of hypothyroidism may increase year by year with the growth of treatment time. Therefore, patients should have their thyroid function reviewed regularly after radioactive iodine treatment.
The following patients are not suitable for radioactive iodine therapy:
1. too young;
2. Pregnant and lactating women;
3. Patients with thyroid crisis;
4. Patients with nodular goiter with cold nodules on thyroid scan;
5. Patients with severe infiltrative proptosis;
6. Patients with peripheral blood leukocytes less than 2.5×109/liter or neutrophils less than 1.5×109/liter.
Surgery for hyperthyroidism
The cure rate of hyperthyroidism can be over 70% with subtotal thyroidectomy, but this surgery can induce thyroid crisis, supraglottic and recurrent laryngeal nerve injury, hypothyroidism and other complications, so it is less commonly used now. Therefore, the following patients are suitable for surgical treatment:
1. patients with severe enlargement of the thyroid gland;
2. Patients who do not want to be treated with isotope therapy because of ineffective medication or recurrence after stopping medication;
3.Nodular goiter with hyperthyroidism;
4.Patients with enlarged thyroid gland behind the sternum.
Note: Patients must take antithyroid medication before surgery, so that the condition can be controlled, the heart rate can be restored to 80-90 beats per minute, and the blood T3 and T4 concentrations can be normalized, and on this basis, iodine should be taken for 2 weeks, otherwise thyroid crisis may be induced. Regular check-ups should also be performed after surgery.
The following patients are not suitable for surgical treatment:
1. Patients with a history of thyroid surgery;
2. patients with severe infiltrative proptosis;
3. Patients with hyperthyroidism in the early (within 3 months) or late (after 6 months) stages of pregnancy;
4.Patients who are old, frail and cannot tolerate surgery.
There are three main treatment methods for hyperthyroidism, especially internal medicine and isotope iodine 131, both of which have their own advantages and disadvantages, and should be selected according to the patient’s condition, age, general condition, medical conditions, and the wishes of the patient and family.