Treatment

The purpose of treatment is to prevent the excessive production of thyroid hormones.
There are three types of treatment: drug therapy (antithyroid medications and iodine preparations in some cases), radioiodine therapy and surgery. The type of treatment is chosen based on factors such as the symptoms of the disease, age and social situation.

Drug therapy

In this treatment, you need to regularly take medication to suppress the synthesis of thyroid hormones (antithyroid medication). Thyroid hormone levels in the blood will return to normal in 1-3 months if the patient takes the proper dosage that is determined based on the severity of his/her condition. Once thyroid hormone levels in the blood return to normal, the symptoms go away and you can lead a normal life.
The important point in drug therapy is that thyroid hormone levels have to be measured regularly while the proper dosage of medication is administered. In patients with mild symptoms of Graves' disease, the necessary dosage of antithyroid medication will decrease. If normal thyroid function is maintained for more than 6 months by taking a tablet every day or two, discontinuation of antithyroid medication can be considered. At our hospital, about 40% of patients were able to stop taking medication within approximately 3 years.

The side effects of antithyroid medication (Mercazole, Thiuragyl [Propacil])
(1) Itchiness, rashes

You may feel itchy or get rashes 2-3 weeks after you start taking antithyroid medication. If these symptoms occur months after the start of the medication, the cause is not related to the antithyroid medication. The symptoms are seen in about one out of every 10 patients.
If you only have mild symptoms of itchiness, they can be successfully treated by taking anti-itch medication in addition to antithyroid medication. If you also have red rashes, it would be better to stop taking the antithyroid medication. Patients with severe symptoms may show inflammation of the mucous membrane of the esophagus or have a fever of about 39 ℃.

(2) Dysfunctions of the liver

Abnormalities in the liver may be caused by hyperthyroidism itself and, in this case, the symptoms will disappear when the thyroid function returns to normal with medication.
In the case of side effects, abnormalities will appear from 2 weeks to 3 months after you start taking the medication as one of two types: elevated AST (GOT) and ALT (GPT) levels or jaundice (yellowish staining of the skin or the white of the eyes). These side effects are considered to occur more frequently with Thiuragyl (Propacil) than with Mercazole. If AST and ALT levels become extremely high or jaundice symptoms appear, the medication has to be discontinued. However, in cases of mild temporal dysfunctions of the liver, the medication can often be continued.

(3) Agranulocytosis

This side effect is characterized by a severe decrease in the number of granulocytes (a type of white blood cell that kills bacteria), and occurs in approximately one out of every 1,000 patients. In many cases, symptoms develop 2 weeks to 3 months after you start taking antithyroid medication. However, it is still worth mentioning that symptoms, although rare, can still develop even after 3 months. Agranulocytosis is a very serious side effect and, left unattended, may lead to death. Symptoms include high fever and severe throat pain, which can easily be mistaken for a common cold and left untreated. For diagnosis, a blood test is urgently needed to determine granulocyte count.

(4) Other uncommon side effects

Joint pains with a fever can occur 2-3 weeks after you start taking antithyroid medication. These joint pains are migratory and the location of the pain may vary every time, but will mainly occur in the joints of both the upper and lower limbs.
Inflammation of the blood vessels of the kidneys or lungs can be seen mainly in patients on Thiuragyl (Propacil). Patients with severe cases of this side effect may show bleeding in the lungs or have kidney failure, which requires dialysis. With this side effect, the blood test for P-ANCA antibodies produces a positive result. The inflammation can occur a few years after the start of the medication and, therefore, you always need to be careful about this side effect while you are on the medication.

Radioiodine (radioactive iodine) therapy

In this treatment you need to take radioactive iodine, which later collects in the thyroid gland and reduces the number of thyroid cells through its radioactive activity. If the number of thyroid cells decreases, the amount of secreted thyroid hormones also decreases. Secretion of thyroid hormones will decrease 2-6 months after you take radioactive iodine capsules. The advantages are that, unlike surgery, a scar does not remain, there is reduced swelling in the neck, and an earlier expected outcome can be obtained by radioiodine therapy than by conventional treatment.
The disadvantage, however, is that even if the disease is treated in the same way, the number of cells may become too low, resulting in underactive thyroid gland functions in some cases. At our hospital, underactive thyroid function develops in about 30% of patients within five years after treatment. Unfortunately, it is difficult to completely prevent the onset of this underactive condition of the thyroid at present.
However, underactive thyroid functions can be easily controlled with thyroid hormone medication. Thyroid hormone medication has no side effects. It is much easier and less stressful to deal with underactive thyroid functions than hyperthyroidism.

The side effects of radioiodine therapy

Many people become concerned because the word "radioactive" reminds them of side effects such as cancer. It has been statistically proven, however, that the amount of radioactivity as small as that used for this treatment has no such side effects on the body. In addition, there is considered to be no impact on offspring. In the U.S., because of the amount of time and cost necessary for recovery, radioiodine therapy is used in 70% of patients with Graves' disease excluding special cases such as expectant and breastfeeding mothers.

Radioiodine therapy and eye symptoms

It has been reported that worsening eye symptoms may occur in about 1% of patients who undergo the radioiodine therapy. It is therefore necessary to have ophthalmologic checkups (specialist consultation and MRI examination) to determine whether radioiodine therapy can be performed.

Surgery

In this treatment, part of the thyroid gland is removed. Like in radioiodine therapy, the purpose of surgery is to prevent the excessive production of thyroid hormones by reducing the number of hormone-producing factories. Surgery is performed once the thyroid function is normalized through medication.
Unlike medication, the most significant advantage of surgery is that the expected outcome can be achieved promptly and with certainty. By undergoing surgery performed by an experienced doctor, 90% of patients will need no further treatment or medication. In some cases, however, recurrence may occur in the remaining part of the thyroid gland, but the signs and symptoms are usually mild.
The disadvantage, on the other hand, is that the thyroid function becomes underactive in some cases, but underactive thyroid functions can be easily controlled with thyroid hormone medication. There are few other disadvantages. For example, a hospital stay is necessary, surgery causes pain to some extent and the surgical incision leaves a scar in the neck. The scar will become less noticeable over time, however.

How to choose your treatment

As described above, each of the three types of treatment has advantages and disadvantages. In addition to medical factors such as the characteristics of each treatment, the severity of swelling in the thyroid gland and thyroid-stimulating antibodies in the blood, the choice of your treatment is also based on personal factors such as your lifestyle, preferences and age. Accordingly, we do hope you will also consider which type of treatment is most suitable for you according to their advantages and disadvantages and participate in the determination of your own treatment.

About the treatment of Graves' ophthalmopathy

Can ophthalmopathy (eye symptoms) be cured if thyroid functions return to normal?

If you take medications for Graves' disease such as Mercazole and propylthiouracil (Thiuragyl and Propacil), your hyperthyroidism will be alleviated. Once the thyroid function returns to normal, eyelid retraction will improve sooner or later in most cases, but other eye symptoms may not be alleviated in many cases. However, if hyperthyroidism is left unattended, it hinders the treatment for eyes. The treatment for the thyroid gland is indispensable.

Why is treatment by an eye specialist necessary?

Before the start of treatment of the thyroid gland, an examination to determine the type and severity of eye problems is needed. This can only be done by an eye specialist who thoroughly understands the eye problems associated with Graves' disease. During the treatment of the thyroid gland, it is also necessary to accurately understand how much the condition of eyes has been improved by the treatment. The degree of improvement is also difficult for doctors other than eye specialists to determine. Our hospital treats eye problems in cooperation with Olympia Eye Hospital.

What exacerbates the condition of Graves' ophthalmopathy?

At present, a clear factor that worsens the condition is smoking. In Graves' disease, patients who smoke are likely to show more severe protruding eyeballs than those who do not smoke.
It is not well known if there are other factors that are associated with eye symptoms, but it is generally considered to be better to avoid situations that could be very stressful to you.

Are the eye problems preventable?

As the cause of eye problems is still unclear, there are no effective means of prevention. However, it is uncommon for eye symptoms to become worse during the treatment of thyroid gland disorders. If you undergo medical tests and treatment in the early stages, you can prevent the disorders from progressing. We do believe that the most effective form of prevention is to stay positive.