Things You'll Need:
- Knowledge
- Medication
- Physician
- Surgeon
-
Step 1
Thionamides (Methimazole or Tapazole and PTU or Propyl-Thyracil):
This is not the definitive treatment for Graves' disease. However, these medicines are almost always used initially to normalize thyroid levels, which is very important before undertaking any of the definitive modes of therapy (see below). People usually normalize in three to eight weeks. Methimazole is preferred because of once daily dosing, more rapid efficacy and lower incidence of side effects.
PTU is preferred during pregnancy because methimazole can cause birth deflects.
ADVANTAGES:
Avoids permanent hypothyroidism
Lower cost
DISADVANTAGES:
Minor side effects: rash, hives, arthralgias, fever, gastrointestinal symptoms
Low risk of agranulocytosis
Risk of fetal goiter and hypothyroidism if pregnant
Frequent visits to the physician -
Step 2
Radio iodine:
After patient has been stabilized with one of the above medications, the next step is to permanently destroy the gland that produces the thyroid hormones. It may look irrational because after the gland is destroyed the patient loses even his normal thyroid secretion and needs to be on life long thyroid hormones supplements. Unfortunately, this is the only best available therapy for Graves' disease at the moment. Permanent ablation of the thyroid gland can be accomplished either by permanently damaging the gland using radio active Iodine (Radio iodine) or by removing it surgically.
ADVANTAGES:
Permanent resolution of hyperthyroidism
DISADVANTAGES:
Permanent hypothyroidism
Radiation precautions for several days after treatment; avoid contact with young children and pregnant women
Rare radiation thyroiditis -
Step 3
Surgery:
ADVANTAGES:
Rapid, permanent cure of hyperthyroidism
DISADVANTAGES:
Permanent hypothyroidism
Risk of hypoparathyroidism, recurrent laryngeal nerve damage, and general anesthesia
High cost -
Step 4
Other drugs may also be used for symptomatic benefits. The most important one is a beta-blocker such as propranolol. This medicine helps to reduce tremor and palpitations associated with graves disease.
