There are three main therapeutic strategies: antithyroid medication, isotope (radioiodine) therapy, and surgery. In many cases, treatment starts with antithyroid medication, and then other treatments are considered in relation to the patient’s age, condition, social situation, and other factors.
In this method, patients regularly take drugs that suppress the production of thyroid hormones. Two types of medication, mercazole and Thiuragyl (propacil), are used. Patients are prescribed a drug regimen based on their condition, and thyroid hormone levels generally return to normal in approximately 1-3 months. The symptoms will disappear, allowing the patient to lead a normal life.
During treatment with medication, it is vital to regularly measure thyroid hormone levels. Patients must also continuously take prescribed drugs, with the dosage determined in relation to their condition. Prescription drug treatment lasts a minimum of two years and patients may need to continue taking medications longer. If normal thyroid function is maintained for at least half a year with the administration of the minimum dosage, concluding drug-based treatment will be considered. However, once a drug regimen is discontinued, it is important to regularly observe a patient’s condition. Thyroid hormone levels may increase again, indicating a recurrence of Basedow’s disease.
During the course of drug treatment, adverse reactions are possible. They occur most frequently 2-3 months following the start of the treatment. Patients need to be examined at the hospital every two weeks during this period.
Iodine in food accumulates in the thyroid gland and is used as a raw material to produce thyroid hormones. Radioactive iodine also accumulates in the thyroid gland, and the radiation it emits degrades thyroid cells. As a result, the production of thyroid hormones is reduced.
After patients begin taking radioactive iodine capsule orally, the thyroid shrinks in size in approximately 2-6 months with thyroid hormone secretion gradually decreasing. However, there are individual differences in therapeutic effects. Whereas the therapy normalizes thyroid function and makes further treatment unnecessary in some patients, it causes hypothyroidism in others. In the latter, a continuing drug regimen to provide the body with thyroid hormones is necessary.
Before and after the therapy, the intake of iodine must be restricted. Also, antithyroid and iodine medications need to cease. Since thyroid hormone levels may fluctuate greatly for 4-6 months after the therapy, patients need to visit the hospital monthly to adjust their medications. Because this type of therapy uses radiation, we do not provide it to patients younger than 18 or to women who are pregnant or breastfeeding.
(1) Q: Is there a risk of cancer because this therapy uses radiation?
A: Statistical studies have demonstrated that there is no risk of cancer from isotope therapy. Furthermore, there is no evidence that this therapy has any effects on the offspring of patients who had previously received isotope therapy.
(2) Q: Will isotope therapy hurt my eyes?
A: It has been reported that approximately 2% of patients received eye care after isotope therapy because their eye symptoms worsened. Given this reality, it is necessary to perform an ophthalmologic examination (medical checkup and MRI) before isotope therapy in order to assess whether the patient is a suitable candidate.
In this method, thyroid tissue that secretes excess levels of hormones is surgically removed. Partial resection is a previously used technique that involves the partial removal of the thyroid gland, leaving a small portion of tissue intact. However, because the recurrence rate of hyperthyroidism was high after partial removal, our hospital performs total resection in which the entire thyroid gland is removed.
Antithyroid drugs, which reduce thyroid hormone levels, can be discontinued the day after surgery. However, lifelong thyroid hormone replacement medication is required after total resection. Thyroid replacement hormones have little risk of adverse reactions. After the dosage becomes stable, medications can be prescribed for longer periods and the frequency of hospital visits is reduced.
(1) Recurrence rate is low.
(2) Levels of anti-TSH receptor antibodies (TRAb) are usually normalized earlier than in subtotal resection.
Each of the therapeutic strategies has advantages and disadvantages. It is necessary to consider the patient’s condition, age, social situation, and other individual factors when selecting an appropriate therapeutic strategy. In addition, since a patient’s condition may change during the course of treatment, the therapeutic strategy may be altered accordingly.
Drug therapy | Isotope (radioiodine) therapy | Surgery | |
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Appropriate Patients | All age groups ・Who can take drugs regularly ・Who have small goiters *Children and women who are pregnant or breastfeeding cannot take some of the medications. |
Women who are not pregnant or breastfeeding, those who do not intend to become pregnant in the near future. Patients over 19 years old who meet one or more of the following conditions: ・Resistant to oral medication ・Experienced adverse drug reactions ・Large goiters ・Desire a early cure for their disease |
Patients who meet one or more of the following conditions: ・Resistant to oral medication ・Experienced adverse drug reactions ・Large goiters ・Desire a fast/swift cure to the disease Thyroid tumors |
Advantages | ・Treatment can proceed on an outpatient basis. ・Treatment can start the day of diagnosis. |
・Therapeutic effects can be achieved in a shorter period of time than in drug treatment. ・The incidence of adverse reactions and complications is low. ・Recurrence is less likely to occur. |
・Therapeutic effects can be achieved earlier than in other treatments. ・Antithyroid drugs can be discontinued the day after surgery. ・The recurrence rate is low. ・Thyroid hormone replacement can be prescribed for long periods of time. |
Disadvantages | ・Many cases require long periods of treatment. | ・A single therapy session may be insufficient. ・It may take more than |
・Scarring on the neck ・Hypothyroidism ・Complications may occur |