Treatments and drugsBy Mayo Clinic staff
The treatment goals for Graves' disease are to inhibit the production of thyroid hormones and to block the effect of the hormones on the body. Some treatments include:
Radioactive iodine therapy
With this therapy, you take radioactive iodine, or radioiodine, by mouth. Because the thyroid needs iodine to produce hormones, it takes up the radioiodine, which destroys the overactive thyroid cells over time. This causes your thyroid gland to shrink, and problems lessen gradually, usually over several weeks to several months.
Radioiodine therapy may increase your risk of new or worsened symptoms of Graves' ophthalmopathy. This side effect is usually mild and temporary, but the therapy may not be recommended if you already have moderate to severe eye problems.
Other side effects may include tenderness in the neck and a temporary increase in thyroid hormones. Men may experience a temporary reduction in testosterone levels. Radioiodine therapy isn't used for treating pregnant or nursing women. Radioiodine not taken up into the thyroid gland is excreted in your urine and saliva.
Because this treatment causes thyroid activity to decline, you'll likely need treatment later to supply your body with normal amounts of thyroid hormones.
Anti-thyroid medications interfere with the thyroid's use of iodine to produce hormones. These prescription medications include propylthiouracil and methimazole (Tapazole).
When these two drugs are used alone, a relapse of hyperthyroidism may occur at a later time. Taking the drug for longer than a year, however, may result in better long-term results. Anti-thyroid drugs may also be used before or after radioiodine therapy as a supplemental treatment.
Side effects of both drugs include rash, joint pain, liver failure or a decrease in disease-fighting white blood cells. Methimazole isn't used to treat pregnant women because of the slight risk of birth defects. Therefore, propylthiouracil is the preferred anti-thyroid drug for pregnant women.
These medications don't inhibit the production of thyroid hormones, but they do block the effect of hormones on the body. They may provide fairly rapid relief of irregular heartbeats, tremors, anxiety or irritability, heat intolerance, sweating, diarrhea and muscle weakness.
Beta blockers include:
- Propranolol (Inderal)
- Atenolol (Tenormin)
- Nadolol (Corgard)
Beta blockers aren't often prescribed for people with asthma, because the drug may trigger attacks. The drug may also complicate management of diabetes. Abruptly discontinuing the use of the drug can cause serious heart problems.
If other therapies aren't an option or haven't been effective, you may need surgery to remove your thyroid (thyroidectomy). After the surgery, you'll likely need treatment to supply your body with normal amounts of thyroid hormones.
Risks of this surgery include potential damage to your vocal cords and your parathyroid glands, tiny glands located adjacent to your thyroid gland. Your parathyroid glands produce a hormone that controls the level of calcium in your blood. Complications are rare under the care of a surgeon experienced in thyroid surgery.
Treating Graves' ophthalmopathy
Mild symptoms of Graves' ophthalmopathy may be managed by using over-the-counter artificial tears during the day and lubricating gels at night. If your symptoms are more severe, your doctor may recommend:
- Corticosteroids. Treatment with prescription corticosteroids, such as prednisone, may diminish swelling behind your eyeballs. Side effects may include fluid retention, weight gain, elevated blood sugar levels, increased blood pressure and mood swings.
- Orbital decompression surgery. In this surgery, your doctor removes the bone between your eye socket (orbit) and your sinuses — the air spaces next to the orbit. This gives your eyes room to move back to their original position. This treatment is usually used if pressure on the optic nerve threatens the loss of vision. Possible complications include double vision.
- Eye muscle surgery. The inflammation caused by Graves' disease can affect your eye muscles, making them too short to allow the eyes to align properly. In eye muscle surgery, your doctor cuts the muscle where it attaches to your eyeball and then reattaches it farther back. Sometimes, more than one operation is necessary.
- Prisms. You may have double vision either because of Graves' disease or as a side effect of surgery for Graves' disease. Though they don't work for everyone, prisms in your glasses may correct your double vision.
- Orbital radiotherapy. Orbital radiotherapy was once a common treatment for Graves' ophthalmopathy. Orbital radiotherapy uses targeted X-rays over the course of several days to destroy some of the tissue behind your eyes. However, some studies have suggested that this treatment provides no benefit for people who have mild to moderately severe Graves' ophthalmopathy. Your doctor may recommend orbital radiotherapy if your eye problems are worsening and prescription corticosteroids alone aren't effective or well tolerated.
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