Nonsurgical Treatment for Hyperthyroidism

At NYU Langone, our doctors recognize that hyperthyroidism can have a significant effect on your everyday life. It can leave you feeling restless, worn out, and irritable. Our team of endocrinologists is committed to finding the best treatment for you.

Medications are often prescribed for the treatment of hyperthyroidism. When choosing one, your doctor takes into account the cause of the condition, how much thyroid hormone your body is making, your age, and any other medical conditions you may have.

Each medication has benefits and risks. Your doctor can discuss these with you.

Antithyroid Medications

Antithyroid medications are typically prescribed first for people with hyperthyroidism—particularly those who have Graves’ disease or toxic thyroid nodules. These medications can effectively control the condition by reducing the amount of hormone the thyroid produces. Although antithyroid medications can manage hyperthyroidism, they don’t cure it. 

Taken by mouth, antithyroid medications are prescribed for as long as you have hyperthyroidism. This may be for only a few weeks, or it could be for many years.

During treatment, your doctor routinely tests your blood to see if the medication is lowering your thyroxine, or T4, levels. He or she may alter the dosage based on this information.

Blood tests may also detect potential adverse effects as soon as possible. These may include allergic reactions; reduced white blood cell levels, which can lead to infection; reduced platelet levels, which can result in bleeding or bruising; abnormal liver test results; joint swelling; and enlarged lymph nodes.

Some people who take antithyroid medications for Graves’ disease, especially people younger than age 35, experience a prolonged remission after one or two years of treatment. Remission is when the signs and symptoms of the condition have disappeared. If this occurs, your doctor may advise you to stop taking the medication, and he or she then monitors you to see if the condition returns. 

Remission may last for months or even years, but most people experience a recurrence. If this happens, a more permanent treatment may be required. 

Although hyperthyroidism due to a toxic nodule or multinodular goiter may respond to antithyroid medications, it almost never goes into permanent remission. You may then need additional treatment, such as radioactive iodine ablation or surgery, to remove or destroy the thyroid partially or fully.

Beta Blockers

Your doctor may also prescribe a beta blocker. These medications don’t change the levels of thyroxine produced by your thyroid. They interfere with the effect thyroxine has on the body and can improve your symptoms within hours or days.

Beta blockers may help slow your heart rate and reduce palpitations, shakiness, and nervousness. They are frequently used until another form of treatment takes effect. They can be taken by mouth in pill form daily.

Doctors also prescribe beta blockers for symptomatic treatment of hyperthyroidism due to thyroiditis, which is inflammation of the thyroid gland. Treatment is only needed until the condition resolves on its own. Additional treatment for people with hyperthyroidism due to thyroiditis might include anti-inflammatory medications, such as prednisone or ibuprofen.

Radioactive Iodine Ablation

If the use of antithyroid medications doesn’t lead to remission, your doctor may prescribe radioactive iodine ablation. This therapy may be used for people with Graves’ disease or for those with toxic nodular or toxic multinodular goiter.

With this therapy, you take a dose of radioactive iodine by mouth. A single dose is usually all that is needed.

Thyroid cells need iodine to make thyroid hormone, so they vigorously absorb any iodine found in the bloodstream, including radioactive iodine. Because radioactive iodine has destructive properties, the thyroid cells that absorb it are destroyed.

Over a period of several weeks to months, radioactive iodine ablation leads to a decrease in thyroxine production. As a result, hyperthyroidism goes away. 

During treatment, your thyroid hormone levels are monitored periodically to assess how your thyroid is responding to the radioactive iodine. Most people experience a reduction in symptoms after just a few weeks to months of treatment. Most people tolerate this therapy very well.

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