Thyroid Problems (cont.)
Thyroid Problems Treatment and Medications
Medications for Hyperthyroidism
Beta-blockers: This class of medication works by blocking many of the body's responses to hyperthyroidism. It decreases tremor, nervousness, and agitation. It also reduces the fast heart rate. Beta blocker tablets are prescribed to a patient with mild to moderate symptoms of hyperthyroidism, and as an IV preparation to the person with the severe form of hyperthyroidism (thyrotoxic crisis). Although beta blockers block the responses to hyperthyroidism, it does not treat the underlying cause.
Propylthiouracil: This antithyroid drug works by blocking thyroid hormone synthesis. It takes several months after starting the medication for the full therapeutic effect to be achieved. The US FDA has issued a guidance that this drug should be used only during the first trimester of pregnancy, or if there is an intolerance to thimazole. Common mild side effects include an itchy rash. More rare, serious side effects include a decrease in white blood cell count, which can decrease the ability to fight off infection. Therefore, a high fever should prompt a call to the doctor.
Methimazole (Tapazole): This is the preferred antithyroid drug in everyone except women in the first trimester of pregnancy for hyperthyroidism. This antithyroid drug also works by blocking thyroid hormone synthesis. It may take slightly longer than propylthiouracil to achieve its full effect. It has similar side effects as propylthiouracil.
Iodide (Lugol's solution, Strong iodine): This medication works by inhibiting the release of thyroid hormone from the overfunctioning thyroid gland. It must be used in conjunction with an antithyroid drug because the iodine can be used to increase the amount of thyroid hormone produced and worsen the hyperthyroidism. Common side effects include nausea and a metallic taste in the mouth.
Radioactive iodine therapy: An endocrinologist or nuclear medicine specialist can treat overactive thyroid conditions with radioactive iodine swallow. This is generally a different type of radioactive iodine than used for diagnostic scans. This treatment takes several months to work by scarring down the thyroid gland, resulting in a smaller- sized gland, often accompanied by hypothyroidism.
Medications for Hypothyroidism
L-thyroxine (Synthroid, Levoxyl, Levothroid, Unithroid, Tirsosint): This medication is the mainstay of thyroid hormone replacement therapy in hypothyroidism. This is a synthetic form of thyroxine. This is exactly the same hormone that the thyroid makes. The body tissues convert it to the active product L-triiodothyronine. Side effects are rare, and it has an excellent safety record. Tirsosint is a new liquid form of levothyroxine in a gelcap that may be easier to absorb in the bloodstream.
Triiodothyronine: This is rarely used alone as thyroid hormone replacement, because it has a much shorter persistence in the blood than L-thyroxine. Its use can cause rapid increases in triiodothyronine concentration, which can be dangerous in the elderly and in people with cardiac disease. It may be used in combination with L-thyroxine for people who have poor symptomatic relief with L-thyroxine alone.
Thyroid extract or "natural" thyroid hormone: This is dried and powdered pig thyroid gland. The hormone is not purified and the exact amount of T4 and T3 can be variable. This is not recommended as a thyroid hormone replacement. There is an excess of T3 in this preparation.
Medications for Thyroid Nodules and Goiter
If the thyroid function is abnormally high or low, then the treatments are as described above.
If the thyroid function is normal with thyroid nodules, there are no good medical treatments to shrink the nodules and surgery is usually suggested. Many years ago it was standard of care to give levothyroxine to "shrink" nodules, but it was found after careful research that administration of thyroid hormone rarely shrinks large nodules.
An emerging treatment of nontoxic goiters/nodules is radioactive iodine therapy. This therapy is used commonly in Europe and South America but is not yet commonly used in all patients in the United States. This treatment is considered when a patient has a large goiter and there are medical problems that prevent a surgical treatment.
Medically Reviewed by a Doctor on 11/10/2014
Stephanie L Lee, MD, PhD, FACE
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