It is important to realise that Graves' Disease is self-limiting in about 50% of cases. The therapies used for the treatment of the disease are summarised below:
1. Beta-Adrenergic BlockersThese are used initially for the tachycardia and tremors as a result of the iodothyronines potentiating the effects of the catecholamines.
2. Antithyroid DrugsThe main antithyroid drugs used are the thiocarbamides, and the most commonly used drug in this group is carbimazole. This drug interferes with reactions that take place in the iodothyronine synthesis. Propylthiouracil is used in the case of Maternal Thyrotoxicosis and can be used as an alternative to carbimazole in those patients with intolerance.
3. Thyroidectomy Thyroidectomy is a procedure where almost the entire thyroid is surgically removed. In the past a partial thyroidectomy (subtotatal thyroidectomy) was performed. Modern fashion is to remove all the thyroid tissue with thyroid supplements by mouth. The modern approach has the advantage that recurrent thyrotoxicosis cannot occur but the operation unless performed by a very experienced surgeon has a significant complication rate.Surgery is indicated in patients where there is compression of the trachea,risk of cancer or the patient has relapsed following drug treatment.
4. Radioactive Iodine (Iodine-131)This is the treatment of choice for many patients. The principle of this treatment is that the thyroid is the only tissue in the body to selectively uptake iodine. The radioactive iodine selectively kills the cells that take up the iodine without causing any harm to the body. A common side effect of this treatment is hypothyroidism.
For an account of radioiodine treatment by one of our patients,see under Radioiodine for Papillary Cancer.