Thyroid storm, a sudden, extreme, life-threatening overactivity of the thyroid gland, requires emergency treatment. Thyroid storm may cause a rapid heartbeat, fever, agitation, psychosis, nausea, vomiting, diarrhea, and shock. It usually occurs in people with untreated or undertreated hyperthyroidism, and is triggered by a factor such as infection, trauma, surgery, uncontrolled diabetes, pregnancy, or labor. Supportive therapy and rapid treatment of the underlying cause are essential.
Your doctor is the best source of information on the drug treatment choices available to you.
Radioactive iodine is commonly used to destroy part of the thyroid gland in treating hyperthyroidism. Radioactive iodine is currently the treatment of choice for hyperthyroidism in the US; especially for patients with Graves' disease. Radioactive iodine taken orally accumulates in the thyroid gland where it destroys the cells that produce thyroid hormones. When using radioactive iodine, physicians attempt to adjust the dosage to destroy only enough of the thyroid to bring hormone production back to normal levels. In practice, however, treatment with radioactive iodine most often results in excessive loss of thyroid function and thyroid hormone deficiency (hypothyroidism). As a result, most patients treated with radioactive iodine ultimately end up having to take thyroid hormone tablets for the rest of their lives; otherwise, patients will experience the symptoms of hypothyroidism (e.g., obesity, depression, muscle and joint diseases).
Radioactive iodine is also very effective treatment for hyperthyroidism due to solitary or multiple thyroid nodules. In these patients, hypothyroidism seldom results from this therapy.
Surgery for hyperthyroidism is generally reserved for special circumstances. Although surgical removal of part of the thyroid gland was once a popular approach to reduce thyroid hormone levels, it is now uncommon in the US. Exceptions include cases in which the patient is allergic to--or will not use--radioactive iodine or antithyroid drugs. In addition, surgery may be performed when the thyroid has grown so large as to obstruct the windpipe or esophagus. Complications of thyroid surgery include excessive loss of thyroid function (hypothyroidism) and a small risk of damaging the vocal cords or other structures in the throat.
Pregnant women with hyperthyroidism should not receive radioactive iodine treatment. Because iodine can cross the placenta, treating pregnant women with radioactive iodine risks destroying the fetal thyroid gland. Treatment with antithyroid medication is usually substituted, but because these drugs also cross the placenta, the lowest effective dose is recommended.
Hyperthyroidism can be controlled effectively, but most people treated for the condition will ultimately develop a deficiency in thyroid hormone production. Hyperthyroidism can have serious complications, but once diagnosed, it can be treated and effectively controlled. Regardless of whether hyperthyroidism is treated with medications, radioactive iodine, or surgery, thyroid hormone deficiency (hypothyroidism) often develops at some point. The natural course of the condition is for the thyroid to produce lower levels of thyroid hormones over time. When that occurs, the deficiency can be controlled by taking a thyroid hormone tablet each day.
Patients taking antithyroid drugs will be seen initially at 4-12 week intervals until their thyroid hormone levels stabilize, and then every 3-4 months thereafter while continuing the medication. If the hyperthyroidism goes into remission and drug therapy is stopped, the American Thyroid Association recommends annual follow-up examinations to monitor weight, pulse, and blood pressure, as well as an annual thyroid and eye examination. Blood levels of thyroid hormones and TSH will be determined as well.
Patients using radioactive iodine will be seen at 4- to 6-week intervals for the first 3 months after therapy, and then at regular intervals as the clinical situation requires. Hypothyroidism generally occurs within 6-12 months after treatment with radioactive iodine, but it may occur at any time, so follow-up should continue indefinitely. When hypothyroidism does occur, thyroid hormone replacement therapy will be prescribed. The American Thyroid Association recommends continuing follow-up on an at least annual basis after radioactive iodine therapy.
For patients who undergo thyroid surgery, follow-up will occur after approximately 2 months to assess thyroid status, and on an annual basis thereafter.
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