Medicine for hyperthyroidism
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Medical Treatments for Hyperthyroidism
Overview of Hyperthyroidism
Hyperthyroidism is a condition characterized by the excessive production of thyroid hormones, leading to symptoms such as tachycardia, heat intolerance, and increased metabolic rate 13. The primary causes include Graves' disease, toxic nodular goitre, and thyroiditis 6.
Antithyroid Medications
Methimazole (MMI) and Propylthiouracil (PTU)
Methimazole (MMI) and Propylthiouracil (PTU) are the main antithyroid drugs used to manage hyperthyroidism. These medications inhibit thyroid hormone synthesis and are used as primary treatments or as preparatory measures before radioiodine therapy or thyroidectomy 47. MMI is generally preferred due to its longer half-life and lower incidence of severe side effects compared to PTU, which can cause fatal liver damage 410. PTU is mainly reserved for pregnant women and thyroid crises 10.
Treatment Regimens
The optimal duration for antithyroid drug therapy is typically between 12 to 18 months. The titration regimen, which involves adjusting the dose based on thyroid hormone levels, is preferred due to fewer adverse effects compared to the block-replace regimen 8. Long-term antithyroid drug therapy has been shown to be effective and safe, maintaining euthyroidism in many patients even after discontinuation 7.
Radioiodine Therapy
Radioiodine therapy is a common treatment for hyperthyroidism, particularly for toxic nodular goitre and Graves' disease. It is well-tolerated and effective, although it carries a risk of inducing hypothyroidism 6. This treatment is generally avoided in children, pregnant women, and lactating mothers 6.
Surgical Options
Thyroidectomy, either subtotal or near-total, is another treatment option, especially for patients who refuse radioiodine therapy or have large goitres causing compression symptoms. The goal is to remove enough thyroid tissue to cure hyperthyroidism while maintaining postoperative euthyroidism 6.
Traditional and Complementary Medicine
Chinese Herbal Medicine
Chinese herbal medicines are often used in combination with conventional antithyroid drugs to treat hyperthyroidism. Studies suggest that these combinations may lower relapse rates, reduce adverse effects, and improve thyroid function and antibody status 1. However, due to methodological limitations, strong evidence supporting the efficacy of Chinese herbal medicine is lacking 1.
Unani Medicine
Unani medicine views hyperthyroidism as a manifestation of excessive energy production due to an imbalance in bile temperament. Treatments focus on restoring this balance, and case studies have shown significant improvements in thyroid profiles and symptoms using Unani pharmacotherapy 35.
Emerging Therapies
New therapeutic strategies for Graves' disease, a common cause of hyperthyroidism, include biologics, small molecule peptides, and immunomodulators. These treatments aim to address the underlying autoimmune mechanisms and have shown promise in clinical trials 9.
Conclusion
The management of hyperthyroidism involves a variety of treatment options, including antithyroid drugs, radioiodine therapy, and surgery. Methimazole is generally preferred over Propylthiouracil due to its safety profile. Traditional and complementary medicines, such as Chinese herbal and Unani medicine, offer additional therapeutic potential, although more robust evidence is needed. Emerging therapies targeting the immunological aspects of Graves' disease represent a promising frontier in hyperthyroidism treatment.
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Most relevant research papers on this topic
Chinese herbal medicines for hyperthyroidism.
Chinese herbal medicines combined with antithyroid drugs may offer benefits in lowering relapse rates, reducing adverse effects, relieving symptoms, and improving thyroid function, but more well-designed trials are needed for strong evidence.
Meta-AnalysisTREATMENT OF HYPERTHYROIDISM WITH A SINGLE DAILY DOSE OF PROPYLTHIOURACIL.
Propylthiouracil is effective in treating hyperthyroidism, its effectiveness may be limited by the presence of other thyroid-drug-resistant bacteria in the body.
The Perspective of Unani Medicine in Understanding Hyperthyroidism.
Unani medicine views hyperthyroidism as a manifestation of excessive energy production, and may help practitioners prevent, treat, and reduce complications by addressing imbalances in temperament.
Systematic ReviewMedical treatment of hyperthyroidism: state of the art.
Methimazole and propylthiouracil are the main antithyroid drugs used for hyperthyroidism, with MMI being the drug of choice due to its widespread availability, longer half-life, and small number of severe side effects.
Role of Unani Medicine in Hyperthyroidism - A Case Report
Unani medicine, specifically Khamira Sandal sda and Anushdaru Sada, effectively improves symptoms and thyroid profile in patients with hyperthyroidism.
Case ReportLong-term treatment of hyperthyroidism with antithyroid drugs: 35 years of personal clinical experience.
Long-term antithyroid drugs (ATD) therapy is effective and safe for treating Graves' hyperthyroidism, resulting in euthyroidism in the majority of patients without causing hypothyroidism.
Systematic Review
Rigorous JournalAntithyroid drug regimen for treating Graves' hyperthyroidism.
The optimal duration of antithyroid drug therapy for Graves' hyperthyroidism is 12 to 18 months, with a titration regimen having fewer adverse effects than the block-replace regimen and being no less effective.
Meta-Analysis
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