Conditions
Hyperthyroidism
Hyperthyroidism develops when the body is exposed to excessive amounts of thyroid hormone. This disorder occurs in almost one percent of all Americans and affects women five to ten times more often than men. In its mildest form, hyperthyroidism may not cause recognizable symptoms. More often, however, the symptoms are discomforting, disabling, or even life-threatening.

Hypothyroidism
Hypothyroidism, or underactivity of the thyroid gland, occurs when the thyroid gland produces less than the normal amount of thyroid hormones. The result is the “slowing down” of many bodily functions. Although hypothyroidism may be temporary, it usually is a permanent condition. Some studies have shown that as many as ten percent of women and three percent of men have hypothyroidism.

Hashimoto’s Thyroiditis
Hashimoto’s thyroiditis, also called autoimmune or chronic lymphocytic thyroiditis, is the most common thyroid disease in the United States. It is an inherited condition that affects approximately 14 million Americans and is about seven times more common in women than in men. Hashimoto’s thyroiditis is characterized by the production of autoantibodies and immune cells by the body’s immune system, which can damage thyroid cells and compromise their ability to make thyroid hormone. Hypothyroidism occurs if the amount of thyroid hormone which can be produced is not enough for the body’s needs. The thyroid gland may also enlarge in some patients, forming a goiter.

Thyroid Nodules
The thyroid gland is located in the lower front of the neck, below the Adam’s apple and above the collarbone. A thyroid nodule is a lump in or on the thyroid gland. Thyroid nodules are common and occur in about 6.4 percent of women and 1.5 percent of men; they are less common in younger patients and increase in frequency with age. Sometimes several nodules will develop in the same person. Any time a lump is discovered in thyroid tissue, the possibility of malignancy (cancer) must be considered. Fortunately, the vast majority of thyroid nodules are benign (not cancerous).

Treatment

Hyperthyroidism
Before the development of current treatment options, the death rate from hyperthyroidism was as high as 50 percent. Now several effective treatments are available, and, with proper management, death from hyperthyroidism is rare. Deciding which treatment is best depends on what caused the hyperthyroidism, its severity, and other conditions present. A physician who is experienced in the management of thyroid diseases can confidently diagnose the cause of hyperthyroidism and prescribe and manage the best treatment program for each patient.

Antithyroid Drugs
In the United States, two drugs are available for treating hyperthyroidism: propylthiouracil (PTU) and methimazole (Tapezole). These medications control hyperthyroidism by slowing thyroid hormone production, and are frequently used for several months after the initial diagnosis of hyperthyroidism to normalize the thyroid hormone levels. Some patients with hyperthyroidism caused by Graves’ disease experience a spontaneous or natural remission of hyperthyroidism after a 12 to 18-month course of treatment with these drugs, and may sometimes avoid permanent underactivity of the thyroid (hypothyroidism), which often occurs as a result of using the other methods of treating hyperthyroidism. Unfortunately, the remission is frequently only temporary, with the hyperthyroidism recurring after several months or years off medication and requiring additional treatment, so relatively few patients are treated solely with antithyroid medication in the United States.

Antithyroid drugs may cause an allergic reaction in about five percent of patients who use them. This usually occurs during the first six weeks of drug treatment. Such a reaction may include rash, hives, fever, or joint pain; but after discontinuing use of the drug, the symptoms resolve within one to two weeks, and there is no permanent damage.

A more serious effect, but occurring in only about one in 250-500 patients during the first four to eight weeks of treatment, is a rapid decrease of white blood cells in the bloodstream. This could increase susceptibility to serious infection. Symptoms such as a sore throat, joint aches, infection, or fever should be reported promptly to your physician; and, a blood cell count should be done immediately. In nearly every case, when a person stops using the medication, the white blood cell count returns to normal.

Very rarely, antithyroid drugs may cause liver problems, which can be detected by monitoring blood tests. Your physician should be contacted if there is yellowing of the skin (“jaundice”), fever, loss of appetite, or abdominal pain.

Radioactive Iodine Treatment
Iodine is an essential ingredient in the production of thyroid hormone. Each molecule of thyroid hormone contains either 4 (T4) or 3 (T3) molecules of iodine. Since most overactive thyroid glands are quite hungry for iodine, it was discovered in the 1940’s that the thyroid could be “tricked” into destroying itself by simply feeding it radioactive iodine. The radioactive iodine is given by mouth, usually in capsule form, and is quickly absorbed from the bowel. It then enters the thyroid cells from the bloodstream and gradually destroys them. Maximal benefit is usually noted within three to six months.

It is not possible to reliably eliminate “just the right amount” of the diseased thyroid gland, since the effects of the radioiodine are slowly progressive on the thyroid cells. Therefore, most endocrinologists strive to completely destroy the diseased thyroid gland with a single dose of radioiodine. This results in the intentional development of an under active thyroid state (hypothyroidism), which is easily, predictably and inexpensively corrected by lifelong daily use of oral thyroid hormone replacement therapy. Although every effort is made to calculate the correct dose of radioiodine for each patient, not every treatment will successfully correct the hyperthyroidism, particularly if the goiter is quite large, and a second dose of radioactive iodine is occasionally needed.

In the 50 plus years and hundreds of thousands of patients (including a former President of the United States and his wife!) in which radioiodine has been used, no serious complications have been reported. Since the treatment appears to be extraordinarily safe, simple, and reliably effective, it is considered by most thyroid specialists in the United States to be the treatment of choice for those types of hyperthyroidism caused by overproduction of thyroid hormones.

Surgical Removal of the Thyroid
Although seldom used now as the preferred treatment for hyperthyroidism, operating to remove most of the thyroid gland may occasionally be recommended in certain situations, such as a pregnant woman with severe disease in whom radioiodine would not be safe for the baby, removal of a clinically suspicious thyroid nodule coexisting with hyperthyroidism, or for rare patients with Graves’ disease who have severe protrusion of their eyes. In such patients, permanent hypothyroidism usually results, and lifelong thyroxine replacement is required.

References
American Association of Clinical Endocrinologists. Thyroid Awareness Campaign 2006: How’s Your Thyroid, Who Needs to Know.