Treatment Overview

There are three treatments for hyperthyroidism. Antithyroid medicine and radioactive iodine are the ones doctors use most often. In rare cases, surgery may be done. Hyperthyroidism can lead to more serious problems. So even if your symptoms are not bothering you, you still need treatment.

The kind of treatment you have depends on your age, what is causing your hyperthyroidism, how much thyroid hormone your body is making, and other medical conditions you may have. Each kind of treatment has benefits and risks. Discuss the benefits and risks of each kind of treatment with your doctor. For some people, more than one kind of treatment may be needed.

Initial treatment

Initial treatment for hyperthyroidism usually is antithyroid medicine or radioactive iodine therapy. If you have a lot of symptoms, your doctor may recommend you take antithyroid medicine first to help you feel better. Then you can decide whether to have radioactive iodine therapy.

• Antithyroid medicines work best if you have mild hyperthyroidism, if this is the first time you are being treated for Graves' disease, if you are younger than 50, or if your thyroid gland is only swollen a little bit (small goiter).
• Radioactive iodine is often recommended if you have Graves' disease and are older than 50, or if you have thyroid nodules (toxic multinodular goiter) that are releasing too much thyroid hormone. Radioactive iodine is not used if:
  • You are pregnant or you want to become pregnant within 6 months of treatment.
  • You are breast-feeding.
  • You have thyroiditis or another kind of hyperthyroidism that is often temporary.

Hyperthyroidism: Should I Use Antithyroid Medicine or Radioactive Iodine?

If you have symptoms such as a fast heartbeat, tremors, sweating, nervousness, or dry eyes, you may take some additional medicines to treat those symptoms.

Surgery is not usually part of initial treatment. You may need surgery if your thyroid gland is so big that you have a hard time swallowing or breathing. Or you may need surgery if a single large thyroid nodule is releasing too much thyroid hormone.

Ongoing treatment

During and after treatment for hyperthyroidism, you will have regular blood tests to check your levels of thyroid-stimulating hormone (TSH). You will also have regular thyroid hormone tests to check your levels of hormones called T4 and T3. These tests are a good way to know how well your treatment is working. If your symptoms do not go away after your initial treatment, you may need to repeat the treatment or try a different treatment.

• If you have Graves' disease and have been taking antithyroid medicine but your hyperthyroidism has not improved, you can continue to take antithyroid medicine or you can try radioactive iodine therapy.
• If you have lots of side effects from antithyroid medicines and radioactive iodine is not an option for you, you may need surgery to remove all or part of your thyroid gland (thyroidectomy).

Sometimes treatment cures your hyperthyroidism but may cause hypothyroidism. Hypothyroidism is the opposite of hyperthyroidism—instead of making too much thyroid hormone, your body is now making too little thyroid hormone. Hypothyroidism is most common after treatment with radioactive iodine. But it can also occur after surgery and sometimes after taking antithyroid medicine.

Be sure to call your doctor if you start to gain weight, feel tired, or feel cold more often than usual. These symptoms may mean you have hypothyroidism and you need to take a different medicine called thyroid hormone medicine. For more information, see the topic Hypothyroidism.

Treatment if the condition gets worse

If radioactive iodine or antithyroid medicines are not working well, you may need:

• Another treatment of radioactive iodine.
• Surgery to remove all or part of your thyroid gland (thyroidectomy).

After treatment with radioactive iodine, you may develop hypothyroidism (too little thyroid hormone). Call your doctor if you have any of the symptoms of hypothyroidism such as gaining weight, feeling tired, or feeling cold more often than usual. If you do have hypothyroidism, you may need to take thyroid hormone medicine for the rest of your life. For more information, see the topic Hypothyroidism.