Propranalol: You will probably be put on beta-blockers whilst you wait to see an Endocrinologist. They relieve some of the symptoms such as palpitations, sweating, tremor and anxiety, by blocking the effects of adrenaline on the heart and other areas of the body. It could also slow down the conversion of T4 into T3. These tablets come in different strengths – 10mg, 40mg, 80mg and 160mg. The normal dose is 20mg three times a day but some people may need more. Because beta-blockers have a good effect on your symptoms, the doctor can then only go by the blood test results for diagnosis.
Antithyroid drugs - Unless you have a goitre pressing on your windpipe, these are usually the first option.
Iodine: This is used in severe cases and before surgery. In the form of drops, Lugol’s iodine, these stop excess thyroid activity in the very short term. It is a mixture of iodine and potassium iodide. Potassium iodide can also be given in the form of tablets.
Carbimazole: The drug most commonly used to lower the hormones made by the thyroid gland. It is prescribed before Iodine 131 treatment or surgery. Carbimazole usually takes 2/3 weeks to work. Dosage varies, depending on the severity of the illness. . You could be on this for up to two years. Your doctor may try you without the medication for a while to see if you are cured, since cure is seen in about 40% of cases. The tablets come in 5mg doses. They are usual prescribed in large doses to begin, the maximum being 60mg per day. It is usual, though, to start with 30mg a day. This is then reduced over 4/8 weeks depending on the response, until a maintenance dose is found, 5 to 15 mg per day. This treatment will sometimes bring down your T4 levels too much, in which case you will be given some thyroxine to make it up – this is called “block and replace”. Some people still feel tired on this regime. Some people in America have been using T3 instead of T4 and they have felt much better. If you want to try this, have a word with your doctor. It could make all the difference!
These tablets are suitable for children and adolescents and women up to the age of forty. They cannot be used during the last month of pregnancy or during breastfeeding. If these tablets do not work then radioiodine/surgery are the next steps.
A rare side effect of this treatment is the lowering of white blood cells, which can make you liable to infection.
Propylthiouracil (PTU): This stops the incorporation of iodine into the thyroid hormones, as well as blocking conversion of T4 to T3. They come in 50mg tablets, the normal starting dose being 450mg per day. Again, this dose is reduced depending on the response until a maintenance dose is found.
These antithyroid drugs are stopped shortly before having radioactive treatment or surgery. This is because when the thyroid hormones are being destroyed, either by radioactive treatment or surgery, they produce large quantities of the hormone causing a “thyroid crisis” or “storm”, which is when excess thyroid hormones cause a high fever, fast pulse and collapse.
Radioactive Iodine 131: This seems to be the chosen option for people over 40 years of age and for those who have ups and downs whilst on Carbimazole. The treatment is given in the nuclear medicine department, at hospital either as a drink or capsule. The dosage depends on your doctor. Some doctors give a dose of 10 milliCuries, which will control the thyotoxicosis, but has less chance of sending you underactive. This may not work as well, though, and some patients will need a further dose in the future. Some doctors give 15 milliCuries to everyone, deliberately causing myxoedema, because myxoedema is easier to deal with. If this happens you will be given thyroxine. You may have a sore neck for a few days. After this treatment you must be careful about being too close to certain people. Your doctor will explain. The treatment takes about 6/8 weeks to work, after which time you will be given another blood test.
SURGERY
This is generally the option for people who have a goitre, pressure on the windpipe or are under the age of 40. Thyroid levels have to be brought to normal however before surgery can be performed. Before surgery, you may be given medication, which will reduce the blood flow to the thyroid gland and reduce its size thus making the operation a little easier to perform. Sometimes not enough of the gland is removed and the patient remains overactive. When too much gland is removed the patient becomes underactive, and will be given thyroxine. The scar left behind is not very noticeable and, anyway, much preferable to overactivity. You will be in hospital for about a week.
All the treatments for hyperactivity are far from perfect and what suits one person will not suit another.
REFERENCES
- Understanding Thyroid Disorders: Dr. A Toft
- Thyroid Disorders - Dr. R Hillson
- Coping with Thyroid Problems - Dr. J Gomez
- Thyroid Problems – Patsy Westcott
- Thyroid Disease: the facts – R I S Bayliss and W M G Tunbridge
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