Treatment of Hyperthyroidism Ⅱ

In the previous installment, we looked at medication treatment and radioactive iodine treatment. Today, I will explain surgery and treatment for symptoms in detail.

3. Surgery Surgery removes thyroid tissue that excessively secretes thyroid hormone, and it is the treatment that can treat hyperthyroidism the fastest. However, it requires hospitalization and is more expensive than medication treatment or radioactive iodine treatment, so it is rarely chosen as the first option. It is considered in cases where the goiter gradually enlarges, when compressive symptoms occur, or when hyperthyroidism recurs after radioactive iodine treatment. In about 5% of cases, recurrence is experienced after a certain period following surgery. In such cases of recurrence after surgery, treatment with radioactive iodine is the most convenient option.

As a side effect of surgery, about 20–25% of surgical patients develop hypothyroidism over the long term. This is less common than in cases treated with radioactive iodine, but permanent hypothyroidism can occur, and in that case thyroid hormone treatment is given. A major complication is hypoparathyroidism, which occurs in less than 1% of cases. Although the frequency is low, if it occurs, permanent treatment is required.

4. Treatment for symptoms

① Treatment of exophthalmos Exophthalmos often appears according to hyperthyroidism, but once symptoms appear, it often follows its own course regardless of the course of hyperthyroidism. Mild symptoms recover to some extent naturally over time, so special treatment is usually not necessary.

The most common mild symptom is swelling of the eyelids, and in such cases, sleeping with the pillow raised helps. If the eyelids do not close well during sleep, an eye mask is used to protect the cornea.

If exophthalmos is severe, or if double vision occurs, or the conjunctiva becomes swollen and red, you must consult a specialist and receive separate special treatment. Once it reaches this stage, it is often difficult to return to normal, but significant improvement can be expected depending on treatment, and medication therapy, including injections, as well as radiation therapy, are combined. If there is no improvement with these methods or the effect is not as expected, surgery is performed.

② Sympathetic nervous system blockers Sympathetic nervous system blockers are used to reduce the sympathetic symptoms seen in hyperthyroidism (symptoms such as palpitations, excessive sweating, and hand tremors). The most commonly used drug is propranolol, a beta-blocker, taken 3–4 times a day. Recently, longer-acting propranolol, atenolol, metoprolol, and other agents that act more selectively on the heart have also been widely used.

③ Administration of tranquilizers and sedatives Stress is a triggering factor for hyperthyroidism, and because this disease also causes a state of nervousness due to increased sympathetic nervous system activity, mental and physical stability are needed, so in some cases the administration of tranquilizers or sedatives is necessary.

So far, I have explained Treatment of Hyperthyroidism Ⅱ. In the next installment, we will look at personalized information for different groups regarding hyperthyroidism.

Source: Korea Disease Control and Prevention Agency, National Health Information Portal