Treatment of hyperthyroidism

treatment

At this stage, the treatment of hyperthyroidism is medication, iodine 131 treatment and surgical treatment. Their main purpose is to reduce the elevated thyroid hormone level. All three therapies are effective, but each has its advantages and disadvantages.

Acute treatment

There is no "acute phase" in the development of hyperthyroidism. Clinically, thyroid crisis is generally regarded as an acute and severe disease of hyperthyroidism, which requires emergency medical treatment and timely rescue, which can be understood as acute treatment.

Thyroid crisis is more common in patients with untreated or inadequate treatment of hyperthyroidism. Once it occurs, it needs to be rescued in time. First, quickly correct water, electrolyte, and acid-base balance disorders, and keep vital signs light. At the same time, drugs (propylthiouracil, iodine, propranolol, glucocorticoids, etc.) are used to inhibit the synthesis and release of thyroid hormones and fight stress, and if necessary, reduce blood thyroid hormone levels through dialysis.

For patients with existing comorbidities and complications, symptomatic treatment should be given, including oxygen supply, prevention and treatment of infection, etc. People with high fever should be given physical cooling and avoid using acetylsalicylic acid drugs (such as aspirin), because acetylsalicylic acid drugs can increase the level of free thyroid hormone in the blood.

General treatment

The general treatment of hyperthyroidism includes paying attention to rest, regular exercise, quitting smoking and limiting alcohol, supplementing sufficient calories and nutrition, and controlling the iodine content in the diet.

At the same time, attention should be paid to avoid the use of iodine-containing drugs (such as amiodarone) and iodine-containing contrast media, and reduce the intake of high-iodine foods such as kelp.

medical treatement

Due to large individual differences, there is no absolute best, fastest, and most effective medication. In addition to commonly used over-the-counter drugs, the most appropriate drug should be selected under the guidance of a doctor in full consideration of personal circumstances.

Antithyroid drugs (ATD)

ATD mainly treats hyperthyroidism by inhibiting the synthesis of thyroid hormones. The cure rate of pure antithyroid drug treatment is only 40%, and the recurrence rate is as high as 50% to 60%. Currently commonly used drugs are formamide imidazole (MMI) and propylthiophene (PTU).

ATD is suitable for patients with mild disease, mild to moderate thyroid enlargement, or those who cannot tolerate surgery due to pregnancy, old age and frailty, and other diseases. In addition, it can also be used in the preparatory stage before surgery and radioactive iodine treatment, patients who relapse after surgery but are not suitable for radioactive iodine therapy, or patients with moderate to severe active Graves ophthalmopathy.

Before treatment with antithyroid drugs, it is recommended to perform routine blood tests and liver function tests, and the test results must be basically normal before it can be used. Pay attention to allergic reactions and toxic reactions when using such drugs, such as neutropenia, skin rash, toxic liver disease, and vasculitis.

Other drugs

beta blockers

It can be used as an adjuvant treatment during the initial treatment of antithyroid drugs. It can quickly control the clinical symptoms of hyperthyroidism and has little effect on thyroid hormone levels. The commonly used drug is propranolol. Patients with asthma, chronic obstructive pulmonary disease and congestive heart failure are contraindicated, and patients with hyperthyroidism during pregnancy should be used with caution.

Iodine

It is used for preoperative preparations, thyroid crisis and severe thyrotoxic heart disease. It can reduce thyroid congestion and inhibit the synthesis and release of thyroid hormones. It is usually given at the same time as antithyroid drugs and is a temporary administration.

Surgical treatment

The advantages of surgical treatment of hyperthyroidism are high surgical cure rate, low mortality, and low recurrence rate. The disadvantage is that there may be a risk of postoperative complications.

Indications and contraindications

Surgical treatment is mainly applicable to the following situations:

Patients with moderate or severe hyperthyroidism, long-term medication is ineffective, relapse after stopping the medication, or patients who are unwilling to take long-term medication;

Those who have a huge thyroid gland or nodules, and have symptoms of compression;

Poststernal goiter with hyperthyroidism;

Nodular goiter with hyperthyroidism;

Patients with hyperthyroidism suspected of malignant transformation.

At the same time need to pay attention to the contraindications of hyperthyroidism surgery:

Those with other serious system diseases;

Those who are in poor general condition and cannot tolerate surgery;

Patients in early and late pregnancy.

Postoperative care

After thyroidectomy, patients need to follow the doctor's prescription for medication. In addition, the patient should be in a semi-recumbent position (upper body elevation is about 30 degrees) to facilitate breathing and drainage of congestion from the surgical incision. In addition, family members should help and encourage patients to actively cough up sputum and keep the airway unobstructed.

Surgical complications

After surgical treatment, patients may experience wound bleeding, respiratory tract infection, recurrent laryngeal or superior laryngeal nerve injury, hypocalcemia caused by hypoparathyroidism, and complications caused by general anesthesia.

Because part or all of the thyroid gland is removed, patients may need to take levothyroxine after surgery to maintain normal thyroid hormone levels in the body, and regularly review thyroid function in accordance with the doctor's guidance.

Other treatments

Radioiodine therapy

The patient takes orally radioactive iodine and uses its rays to destroy the thyroid tissue and reduce the release of thyroid hormones. This treatment has a high cure rate and a relatively low recurrence rate.

Indications and contraindications

Radioactive iodine therapy is mainly suitable for the following situations:

Moderate or above goiter;

Anti-thyroid drug allergy;

Recurrence after antithyroid drugs or surgical treatment;

Hyperthyroidism combined with damage to organs such as heart, liver and kidney;

Patients who refuse surgical treatment or have surgical contraindications.

Try to avoid radioactive iodine therapy for moderate to severe active exophthalmos, and prohibit radioactive iodine therapy during pregnancy and lactation.

Precautions

Hypothyroidism can occur after this treatment, which is considered to be one of the signs of hyperthyroidism cure. After radioiodine treatment, thyroid function should be monitored regularly, hypothyroidism should be detected as soon as possible, and hormone replacement therapy should be given. After treatment, some patients may develop radiation thyroiditis, thyroid crisis or hyperthyroidism aggravated in a short time, and need to follow the doctor's advice for observation, follow-up and treatment.

Patients should have a low-iodine diet 1 to 2 weeks before receiving radioactive iodine treatment, and avoid using iodine-containing contrast media and drugs.

Treatment of Graves Eye Disease

Under normal circumstances, pillows are raised while sleeping, smoking cessation, and sodium restriction can alleviate the condition. Wear colored glasses to protect your eyes during the day, use artificial tears, and use 1% methylcellulose eye drops at night. Those who cannot close their eyelids during sleep can use saline gauze to compress their eyes or wear an eye mask to protect the cornea.

Patients with moderate to severe active Graves ophthalmopathy should receive glucocorticoid therapy. If glucocorticoid or glucocorticoid therapy is not tolerable, or the patient has corneal infection or ulcer, retina or optic neuropathy caused by compression may cause blindness, orbital decompression surgery is required.

Treatment of hyperthyroidism during pregnancy

Timing of pregnancy

Generally speaking, pregnancy is not recommended for patients with uncontrolled hyperthyroidism. Patients who are receiving anti-thyroid medication, after their thyroid function returns to normal, consult their doctor if they can become pregnant.

Medications during pregnancy

Because anti-thyroid drugs can cause fetal malformations and inhibit fetal thyroid function, if possible, during pregnancy, especially the first 12 weeks of pregnancy, try not to take anti-thyroid drugs. If anti-thyroid drugs are really needed, it should be based on the mother’s serum free thyroxine ( FT4) The content of the drug is adjusted, and propylthiouracil is preferred for treatment in the first 12 weeks of pregnancy.

Breastfeeding medication

If breastfeeding women need anti-thyroid medication, they should weigh the pros and cons of the medication and try to use a smaller dose of anti-thyroid medication.

Mothers should take the medicine after breastfeeding.