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home : columns : dr. k May 25, 2016

12/19/2013 11:21:00 AM
Treat hyperthyroidism with one of three options

DEAR DOCTOR K: What are the treatment options for hyperthyroidism? Can you discuss the pros and cons of each one?

DEAR READER: The thyroid gland in your neck makes thyroid hormone. This chemical circulates in the blood and affects the functioning of every cell in your body. It is essential for life, but you need to have just the right amount circulating, not too much and not too little.

Normally, your thyroid gland doles out just the right amount of thyroid hormone to keep your body running smoothly. But sometimes the thyroid does not produce enough hormone, slowing down all of your body's functions. This condition is called hypothyroidism, or underactive thyroid. Or the thyroid can produce too much hormone, sending your systems into overdrive. This condition is known as hyperthyroidism, or overactive thyroid.

A person with hyperthyroidism can experience a range of symptoms including insomnia, excess sweating, racing heartbeat, shortness of breath, exhaustion, nervousness, weight loss, a voracious appetite and diarrhea.

The goal of treatment is to stop the thyroid gland from making too much thyroid hormone and to fight the effects of too much hormone. There are three ways to do this:

-- Radioactive iodine destroys part of your thyroid in order to reduce your body's production of thyroid hormone. Your doctor must estimate how much radioactive iodine to give you to make your thyroid gland produce normal levels of hormone.

But it is next to impossible to be exact and to get it "just right." Doctors would rather err in the direction of giving you a high-enough dose to make sure an overactive thyroid gland is fixed once and for all. As a result, unless a person is lucky, the dose of the radioactive iodine will be slightly more than required -- and your thyroid will be underactive from now on.

That's an easy problem to deal with. You will take thyroid hormone for the rest of your life. A pill will give you the extra thyroid hormone you need, because your thyroid gland is not making it. Side effects (from a proper dose) are minimal, and the treatment leaves you feeling well.

-- Anti-thyroid drugs block the thyroid gland's ability to make the hormone. The advantage of anti-thyroid drugs is that they do not leave your thyroid permanently damaged. The downside is that you can't predict how long you'll need to take them. And, although it doesn't happen often, the drugs can produce serious side effects, including liver failure.

-- Surgery to remove all or part of the thyroid is safe and highly effective. But if your entire thyroid gland is removed, your body will no longer produce thyroid hormone. As a result, you will become hypothyroid and need thyroid hormone replacement for life.

The final treatment decision rests on a number of factors, including your age, the cause of your condition and its severity. Make sure you understand the benefits and drawbacks of your options. And don't hesitate to seek a second opinion from a thyroid specialist.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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