What is the best way to treat hyperthyroidism?

  There are three main treatments for hyperthyroidism in Graves’ disease, including internal antithyroid drug (ATD) therapy, 131I therapy in nuclear medicine, and surgical treatment.  Internal ATD treatment is relatively mild, and the dosage can be adjusted in time during treatment. Another disadvantage of ATD treatment is that it is easy to relapse when the medication is stopped or reduced, and the relapse rate of ATD treatment is reported to be about 40-60%.  Iodine-131 therapy is easy to use, and usually only one dose of iodine-131 is administered, and the symptoms of hyperthyroidism start to improve about 4 weeks after treatment. Iodine-131 treatment does not cause any damage to liver, kidney function or hematopoietic function. Therefore, it is suitable for the treatment of hyperthyroidism patients who have abnormal liver and kidney function or decreased blood cells due to ATD treatment. Some patients with no significant improvement in symptoms or incomplete remission after six months of iodine-131 treatment may be retreated with iodine-131 again. A major complication of iodine-131 therapy is hypothyroidism. Some people with early-onset hypothyroidism can recover with thyroid hormone replacement therapy, and those who cannot recover simply need daily supplemental thyroid hormone replacement therapy.  Surgery is usually used to treat hyperthyroidism by subtotal thyroidectomy, which is a rapid treatment for hyperthyroidism and is especially suitable for patients with significantly enlarged thyroid gland with proptosis and hyperthyroidism with nodules, but its shortcoming is that it is invasive and may cause complications such as damage to the laryngeal nerve and hypoparathyroidism in some cases. Some patients still have recurrence of hyperthyroidism or hypothyroidism after surgery.