Thyroidism Research Paper
Part 1: INTRODUCTION TO HYPERTHYROIDISM
Hyperthyroidism is a large topic so we have split it into four manageable sized portions.
This page introduces hyperthyroidism. Subsequent pages are listed at the bottom which address more specific details of making the diagnosis of hyperthyroidism, the causes of hyperthyroidism, and different treatment options available for hyperthyroidism.
In healthy people, the thyroid makes just the right amounts of two hormones, T4 and T3, which have important actions throughout the body. These hormones regulate many aspects of our metabolism, eventually affecting how many calories we burn, how warm we feel, and how much we weigh. In short, the thyroid "runs" our metabolism. These hormones also have direct …show more content…
effects on most organs, including the heart which beats faster and harder under the influence of thyroid hormones. Essentially all cells in the body will respond to increases in thyroid hormone with an increase in the rate at which they conduct their business. Hyperthyroidism is the medical term to describe the signs and symptoms associated with an over production of thyroid hormone. For an overview of how thyroid hormone is produced and how its production is regulated check out our thyroid hormone production page.
Hyperthyroidism is a condition caused by the effects of too much thyroid hormone on tissues of the body.
Although there are several different causes of hyperthyroidism, most of the symptoms that patients experience are the same regardless of the cause (see the list of symptoms below). Because the body's metabolism is increased, patients often feel hotter than those around them and can slowly lose weight even though they may be eating more. The weight issue is confusing sometimes since some patients actually gain weight because of an increase in their appetite. Patients with hyperthyroidism usually experience fatigue at the end of the day, but have trouble sleeping. Trembling of the hands and a hard or irregular heartbeat (called palpitations) may develop. These individuals may become irritable and easily upset. When hyperthyroidism is severe, patients can suffer shortness of breath, chest pain, and muscle weakness. Usually the symptoms of hyperthyroidism are so gradual in their onset that patients don't realize the symptoms until they become more severe. This means the symptoms may continue for weeks or months before patients fully realize that they are sick. In older people, some or all of the typical symptoms of hyperthyroidism may be absent, and the patient may just lose weight or become …show more content…
depressed.
Common symptoms and signs of hyperthyroidism Palpitations Heat intolerance Nervousness Insomnia Breathlessness Increased bowel movements Light or absent menstrual periods Fatigue
Fast heart rate Trembling hands Weight loss Muscle weakness Warm moist skin Hair loss Staring gaze
Remember, the words "signs" and "symptoms" have different medical meanings. Symptoms are those problems that a patient notices or feels. Signs are those things that a physician can objectively detect or measure. For instance, a patient will feel hot, this is a symptom. The physician will touch the patient's skin and note that it is warm and moist, this is a sign.
Part 2: CAUSES OF HYPERTHYROIDISM There are several causes of hyperthyroidism. Most often, the entire gland is overproducing thyroid hormone This is called Graves Disease. Less commonly, a single nodule is responsible for the excess hormone secretion. We call this a "hot" nodule.
The most common underlying cause of hyperthyroidism is Graves' disease, a condition named for an Irish doctor who first described the condition. This condition can be summarized by noting that an enlarged thyroid (enlarged thyroids are called goiters) is producing way too much thyroid hormone. [Remember that only a small percentage of goiters produce too much thyroid hormone, the majority of thyroid goiters actually become large because they are not producing enough thyroid hormone]. Graves' disease is classified as an autoimmune disease, a condition caused by the patient's own immune system turning against the patient's own thyroid gland. The hyperthyroidism of Graves' disease, therefore, is caused by antibodies that the patient's immune system makes which attach to specific activating sites on thyroid gland which in turn cause the thyroid to make more hormone. There are actually three distinct parts of Graves' disease: [1] overactivity of the thyroid gland (hyperthyroidism), [2] inflammation of the tissues around the eyes causing swelling, and [3] thickening of the skin over the lower legs (pretibial myxedema). Most patients with Graves' disease, however, have no obvious eye involvement. Their eyes may feel irritated or they may look like they are staring. About one out of 20 people with Graves' disease will suffer more severe eye problems, which can include bulging of the eyes, severe inflammation, double vision, or blurred vision. If these serious problems are not recognized and treated, they can permanently damage the eyes and even cause blindness. Thyroid and eye involvement in Graves' disease generally run a parallel course, with eye problems resolving slowly after hyperthyroidism is controlled.
Characteristics of Graves Disease Graves Disease effects women much more often than men (about 8:1 ratio, thus 8 women get Graves Disease for every man that gets it.
Graves Disease is often called diffuse toxic goiter because the entire thyroid gland is enlarged, usually moderately enlarged, sometimes quite big.
Graves disease is uncommon over the age of 50 (more common in the 30's and 40's)
Graves Disease tends to run in families (not known why)
Other Less Common Causes of Hyperthyroidism
Hyperthyroidism can also be caused by a single nodule within the thyroid instead of the entire thyroid. As outlined in detail on our nodules page, thyroid nodules usually represent benign (non-cancerous) lumps or tumors in the gland. These nodules sometimes produce excessive amounts of thyroid hormones. This condition is called "toxic nodular goiter". The picture on the right is an iodine scan (also simply called a thyroid scan) which shows a normal sized thyroid gland (shaped like a butterfly). This scan is abnormal because a solitary "hot" nodule is located in the right lower lobe. This single nodule is comprised of thyroid cells which have lost their regulatory mechanism which dictates how much hormone to produce. Without this regulatory control, the cells in this nodule produce thyroid hormone at a dramatically increased rate causing the symptoms of hyperthyroidism. [As a point of reference, some nodules are "cold" since they don't produce any hormone at all. There is a picture of a cold nodule on the nodule page.]
Inflammation of the thyroid gland, called thyroiditis, can lead to the release of excess amounts of thyroid hormones that are normally stored in the gland. In subacute thyroiditis, the painful inflammation of the gland is believed to be caused by a virus, and the hyperthyroidism lasts a few weeks. A more common painless form of thyroiditis occurs in one out of 20 women, a few months after delivering a baby and is, therefore, known as postpartum thyroiditis. Although hyperthyroidism caused by thyroiditis causes the typical symptoms listed on our introduction to hyperthyroidism page, they generally last only a few weeks until the thyroid hormone stored in the gland has been exhausted. For more about thyroiditis see our page on this topic.
Hyperthyroidism can also occur in patients who take excessive doses of any of the available forms of thyroid hormone. This is a particular problem in patients who take forms of thyroid medication that contains T3, which is normally produced in relatively small amounts by the human thyroid gland. Other forms of hyperthyroidism are even rarer. It is important for your doctor to determine which form of hyperthyroidism you may have since the best treatment options will change depending on the underlying cause.
Part 3: MAKING THE DIAGNOSIS OF HYPERTHYROIDISM
The actual diagnosis of hyperthyroidism is easy to make once its possibility is entertained. Accurate and widely available blood tests can confirm or rule out the diagnosis quite easily within a day or two. Levels of the thyroid hormones themselves, T4 and T3 are measured in blood and one or both must be high for this diagnosis to be made. It is also useful to measure the level of thyroid-stimulating hormone (TSH). This hormone is secreted from the pituitary gland (shown in orange) with the purpose of stimulating the thyroid to produce thyroid hormone. The pituitary constantly monitors our thyroid hormone levels and, if it senses the slightest excess of thyroid hormone in blood, it stops producing TSH. Consequently, a low blood TSH strongly suggests that the thyroid is overproducing hormone on its own. Other special tests are occasionally use to distinguish among the various causes of hyperthyroidism. Because the thyroid gland normally takes up iodine in order to make thyroid hormones, measuring how much radioactive iodine or technetium is captured by the gland can be a very useful way to measure its function. The dose of radiation with these tests is very small and has no side effects. Such radioactive thyroid scan and uptake tests are often essential to know what treatment should be used in a patient with hyperthyroidism. This is easily demonstrated on our causes of hyperthyroidism page which shows a hot nodule.
Common tests used to diagnose hyperthyroidism Thyroid stimulating hormone (TSH) produced by the pituitary [will be decreased in hyperthyroidism]. Thus, the diagnosis of hyperthyroidism is nearly always associated with a LOW (suppressed) TSH level. If the TSH levels are not low, then other tests must be run.
Thyroid hormones themselves (T3, T4, T7) [will be increased]. It should be obvious to you by know that for a patient to have hyperthyroidism they must have high thyroid hormone levels. Sometimes all of the different thyroid hormones are not high and only one or two of the different thyroid hormone measurements are high. This is not too common, as most people with hyperthyroidism will have all of their thyroid hormone measurements high (except TSH).
Iodine thyroid scan [will show if the cause is a single nodule or the whole gland]
Part 4: TREATMENT OPTIONS FOR HYPERTHYROIDISM There are readily available and effective treatments for all common types of hyperthyroidism.
Some of the symptoms of hyperthyroidism such as tremor and palpitations which are caused by excess thyroid hormone acting on the cardiac and nervous system can be improved within a number of hours by medications called beta-blockers (e.g., propranolol; Inderal). These drugs block the effect of the thyroid hormone but don't have an effect on the thyroid itself, thus Beta-blockers do not cure the hyperthyroidism and do not decrease the amount of thyroid hormone being produced, they just prevent some of the symptoms. For patients with temporary forms of hyperthyroidism (thyroiditis or taking excess thyroid medications), beta blockers may be the only treatment required. Once the thyroiditis (inflammation of the thyroid gland) resolves and goes away, the patient can be taken off of these
drugs.
Anti-Thyroid Drugs
For patients with sustained forms of hyperthyroidism, such as Graves' disease or toxic nodular goiter, antithyroid medications are often used. The goal with this form of drug therapy is to prevent the thyroid from producing hormones. Two common drugs in this category are methimazole and propylthiouracil (PTU) both of which actually interfere with the thyroid gland's ability to make its hormones. The illustration shows that some hormone is made, but the thyroid becomes much less efficient. When taken faithfully, these drugs are usually very effective in controlling hyperthyroidism within a few weeks. Antithyroid drugs can have side effects such as rash, itching, or fever, but these are uncommon. Very rarely, patients treated with these medications can develop liver inflammation or a deficiency of white blood cells therefore, patients taking antithyroid drugs should be aware that they must stop their medication and call their doctor promptly if they develop yellowing of the skin, a high fever, or severe sore throat. The main shortcoming of antithyroid drugs is that the underlying hyperthyroidism often comes back after they are discontinued. For this reason, many patients with hyperthyroidism are advised to consider a treatment that permanently prevents the thyroid gland from producing too much thyroid hormone.
Radioactive Iodine Treatment Radioactive iodine is the most widely recommended permanent treatment of hyperthyroidism. This treatment takes advantage of the fact that thyroid cells are the only cells in the body which have the ability to absorb iodine. In fact, thyroid hormones are experts at doing just that. By giving a radioactive form of iodine gives off a poisonous type of radiation, the thyroid cells which absorb it will be damaged or killed. Because iodine is not concentrated by any other cells in the body, there is very little radiation exposure (or side effects!) for the rest of the body. Radioiodine can be taken by mouth without the need to be hospitalized. This form of therapy often takes one to two months before the thyroid has been killed, but the radioactivity medicine is completely gone from the body within a few days. The majority of patients are cured with a single dose of radioactive iodine. The only common side effect of radioactive iodine treatment is underactivity of the thyroid gland. The problem here, is that the amount of radioactive iodine given kills too many of the thyroid cells so that the remaining thyroid does not produce enough hormone, a condition called hypothyroidism. There is no evidence that radioactive iodine treatment of hyperthyroidism causes cancer of the thyroid gland or other parts of the body, or that it interferes with a woman's chances of becoming pregnant and delivering a healthy baby in the future. It is also important to realize that there are different types of radioactive iodine (isotopes). The type used for thyroid scans (iodine scans) as shown in the picture below give up a much milder type of radioactivity which does NOT kill thyroid cells.
Surgical Removal of the Gland or Nodule Another permanent cure for hyperthyroidism is to surgically remove all or part. Surgery is not used as frequently as the other treatments for this disease. The biggest reason for this is that the most common forms of hyperthyroidism are a result of overproduction from the entire gland (Graves' Disease) and the methods described above work quite well in the vast majority of cases. Although there are some Graves' Disease patients who will need to have surgical removal of their thyroid (cannot tolerate medicines for one reason or another, or who refuse radioactive iodine), other causes of hyperthyroidism can be better suited for surgical treatment earlier in the disease. One such case is illustrated here where a patient has hyperthyroidism due to a hot nodule in the lower aspect of the right thyroid lobe. Depending on the location of the nodule, the surgeon can remove the lower portion of the lobe as illustrated on the left, or he/she may need to remove the entire lobe which contains the hot nodule as shown in the second picture. This should provide a long term cure.
Concerns about long hospitalizations following thyroid surgery have been all but alleviated over the past few years since many surgeons are now sending their patients home the morning following surgery (23 hour stay). This of course depends on the underlying health of the patient and their age, among other factors. Some are even treating partial thyroidectomy as an out patient procedure where healthy patients can be sent home a few hours post op. Although most surgeons require that the patient be put to sleep for operations on the thyroid gland, a some are even removing one side of the gland under local anesthesia with the aid of IV sedation. These smaller operations tend to be associated with fewer complaints.
A potential down side of the surgical approach is that there is a small risk of injury to structures near the thyroid gland in the neck including the nerve to the voice box (the recurrent laryngeal nerve). The incidence of this is about 1%. Like radioactive iodine treatment, surgery often results in hypothyroidism. This fact is obvious when the entire gland is removed, but it may occur following a lobectomy as well. Whenever hypothyroidism occurs after treatment of an overactive thyroid gland, it can be easily diagnosed and effectively treated with levothyroxine. Levothyroxine fully replaces thyroid hormones deficiency and, when used in the correct dose , can be safely taken for the remainder of a patient's life without side effects or complications. Just one small pill per day.
Hyperthyroidism is a large topic so we have split it into four manageable sized portions.
This page introduces hyperthyroidism. Subsequent pages are listed at the bottom which address more specific details of making the diagnosis of hyperthyroidism, the causes of hyperthyroidism, and different treatment options available for hyperthyroidism.
In healthy people, the thyroid makes just the right amounts of two hormones, T4 and T3, which have important actions throughout the body. These hormones regulate many aspects of our metabolism, eventually affecting how many calories we burn, how warm we feel, and how much we weigh. In short, the thyroid "runs" our metabolism. These hormones also have direct …show more content…
effects on most organs, including the heart which beats faster and harder under the influence of thyroid hormones. Essentially all cells in the body will respond to increases in thyroid hormone with an increase in the rate at which they conduct their business. Hyperthyroidism is the medical term to describe the signs and symptoms associated with an over production of thyroid hormone. For an overview of how thyroid hormone is produced and how its production is regulated check out our thyroid hormone production page.
Hyperthyroidism is a condition caused by the effects of too much thyroid hormone on tissues of the body.
Although there are several different causes of hyperthyroidism, most of the symptoms that patients experience are the same regardless of the cause (see the list of symptoms below). Because the body's metabolism is increased, patients often feel hotter than those around them and can slowly lose weight even though they may be eating more. The weight issue is confusing sometimes since some patients actually gain weight because of an increase in their appetite. Patients with hyperthyroidism usually experience fatigue at the end of the day, but have trouble sleeping. Trembling of the hands and a hard or irregular heartbeat (called palpitations) may develop. These individuals may become irritable and easily upset. When hyperthyroidism is severe, patients can suffer shortness of breath, chest pain, and muscle weakness. Usually the symptoms of hyperthyroidism are so gradual in their onset that patients don't realize the symptoms until they become more severe. This means the symptoms may continue for weeks or months before patients fully realize that they are sick. In older people, some or all of the typical symptoms of hyperthyroidism may be absent, and the patient may just lose weight or become …show more content…
depressed.
Common symptoms and signs of hyperthyroidism Palpitations Heat intolerance Nervousness Insomnia Breathlessness Increased bowel movements Light or absent menstrual periods Fatigue
Fast heart rate Trembling hands Weight loss Muscle weakness Warm moist skin Hair loss Staring gaze
Remember, the words "signs" and "symptoms" have different medical meanings. Symptoms are those problems that a patient notices or feels. Signs are those things that a physician can objectively detect or measure. For instance, a patient will feel hot, this is a symptom. The physician will touch the patient's skin and note that it is warm and moist, this is a sign.
Part 2: CAUSES OF HYPERTHYROIDISM There are several causes of hyperthyroidism. Most often, the entire gland is overproducing thyroid hormone This is called Graves Disease. Less commonly, a single nodule is responsible for the excess hormone secretion. We call this a "hot" nodule.
The most common underlying cause of hyperthyroidism is Graves' disease, a condition named for an Irish doctor who first described the condition. This condition can be summarized by noting that an enlarged thyroid (enlarged thyroids are called goiters) is producing way too much thyroid hormone. [Remember that only a small percentage of goiters produce too much thyroid hormone, the majority of thyroid goiters actually become large because they are not producing enough thyroid hormone]. Graves' disease is classified as an autoimmune disease, a condition caused by the patient's own immune system turning against the patient's own thyroid gland. The hyperthyroidism of Graves' disease, therefore, is caused by antibodies that the patient's immune system makes which attach to specific activating sites on thyroid gland which in turn cause the thyroid to make more hormone. There are actually three distinct parts of Graves' disease: [1] overactivity of the thyroid gland (hyperthyroidism), [2] inflammation of the tissues around the eyes causing swelling, and [3] thickening of the skin over the lower legs (pretibial myxedema). Most patients with Graves' disease, however, have no obvious eye involvement. Their eyes may feel irritated or they may look like they are staring. About one out of 20 people with Graves' disease will suffer more severe eye problems, which can include bulging of the eyes, severe inflammation, double vision, or blurred vision. If these serious problems are not recognized and treated, they can permanently damage the eyes and even cause blindness. Thyroid and eye involvement in Graves' disease generally run a parallel course, with eye problems resolving slowly after hyperthyroidism is controlled.
Characteristics of Graves Disease Graves Disease effects women much more often than men (about 8:1 ratio, thus 8 women get Graves Disease for every man that gets it.
Graves Disease is often called diffuse toxic goiter because the entire thyroid gland is enlarged, usually moderately enlarged, sometimes quite big.
Graves disease is uncommon over the age of 50 (more common in the 30's and 40's)
Graves Disease tends to run in families (not known why)
Other Less Common Causes of Hyperthyroidism
Hyperthyroidism can also be caused by a single nodule within the thyroid instead of the entire thyroid. As outlined in detail on our nodules page, thyroid nodules usually represent benign (non-cancerous) lumps or tumors in the gland. These nodules sometimes produce excessive amounts of thyroid hormones. This condition is called "toxic nodular goiter". The picture on the right is an iodine scan (also simply called a thyroid scan) which shows a normal sized thyroid gland (shaped like a butterfly). This scan is abnormal because a solitary "hot" nodule is located in the right lower lobe. This single nodule is comprised of thyroid cells which have lost their regulatory mechanism which dictates how much hormone to produce. Without this regulatory control, the cells in this nodule produce thyroid hormone at a dramatically increased rate causing the symptoms of hyperthyroidism. [As a point of reference, some nodules are "cold" since they don't produce any hormone at all. There is a picture of a cold nodule on the nodule page.]
Inflammation of the thyroid gland, called thyroiditis, can lead to the release of excess amounts of thyroid hormones that are normally stored in the gland. In subacute thyroiditis, the painful inflammation of the gland is believed to be caused by a virus, and the hyperthyroidism lasts a few weeks. A more common painless form of thyroiditis occurs in one out of 20 women, a few months after delivering a baby and is, therefore, known as postpartum thyroiditis. Although hyperthyroidism caused by thyroiditis causes the typical symptoms listed on our introduction to hyperthyroidism page, they generally last only a few weeks until the thyroid hormone stored in the gland has been exhausted. For more about thyroiditis see our page on this topic.
Hyperthyroidism can also occur in patients who take excessive doses of any of the available forms of thyroid hormone. This is a particular problem in patients who take forms of thyroid medication that contains T3, which is normally produced in relatively small amounts by the human thyroid gland. Other forms of hyperthyroidism are even rarer. It is important for your doctor to determine which form of hyperthyroidism you may have since the best treatment options will change depending on the underlying cause.
Part 3: MAKING THE DIAGNOSIS OF HYPERTHYROIDISM
The actual diagnosis of hyperthyroidism is easy to make once its possibility is entertained. Accurate and widely available blood tests can confirm or rule out the diagnosis quite easily within a day or two. Levels of the thyroid hormones themselves, T4 and T3 are measured in blood and one or both must be high for this diagnosis to be made. It is also useful to measure the level of thyroid-stimulating hormone (TSH). This hormone is secreted from the pituitary gland (shown in orange) with the purpose of stimulating the thyroid to produce thyroid hormone. The pituitary constantly monitors our thyroid hormone levels and, if it senses the slightest excess of thyroid hormone in blood, it stops producing TSH. Consequently, a low blood TSH strongly suggests that the thyroid is overproducing hormone on its own. Other special tests are occasionally use to distinguish among the various causes of hyperthyroidism. Because the thyroid gland normally takes up iodine in order to make thyroid hormones, measuring how much radioactive iodine or technetium is captured by the gland can be a very useful way to measure its function. The dose of radiation with these tests is very small and has no side effects. Such radioactive thyroid scan and uptake tests are often essential to know what treatment should be used in a patient with hyperthyroidism. This is easily demonstrated on our causes of hyperthyroidism page which shows a hot nodule.
Common tests used to diagnose hyperthyroidism Thyroid stimulating hormone (TSH) produced by the pituitary [will be decreased in hyperthyroidism]. Thus, the diagnosis of hyperthyroidism is nearly always associated with a LOW (suppressed) TSH level. If the TSH levels are not low, then other tests must be run.
Thyroid hormones themselves (T3, T4, T7) [will be increased]. It should be obvious to you by know that for a patient to have hyperthyroidism they must have high thyroid hormone levels. Sometimes all of the different thyroid hormones are not high and only one or two of the different thyroid hormone measurements are high. This is not too common, as most people with hyperthyroidism will have all of their thyroid hormone measurements high (except TSH).
Iodine thyroid scan [will show if the cause is a single nodule or the whole gland]
Part 4: TREATMENT OPTIONS FOR HYPERTHYROIDISM There are readily available and effective treatments for all common types of hyperthyroidism.
Some of the symptoms of hyperthyroidism such as tremor and palpitations which are caused by excess thyroid hormone acting on the cardiac and nervous system can be improved within a number of hours by medications called beta-blockers (e.g., propranolol; Inderal). These drugs block the effect of the thyroid hormone but don't have an effect on the thyroid itself, thus Beta-blockers do not cure the hyperthyroidism and do not decrease the amount of thyroid hormone being produced, they just prevent some of the symptoms. For patients with temporary forms of hyperthyroidism (thyroiditis or taking excess thyroid medications), beta blockers may be the only treatment required. Once the thyroiditis (inflammation of the thyroid gland) resolves and goes away, the patient can be taken off of these
drugs.
Anti-Thyroid Drugs
For patients with sustained forms of hyperthyroidism, such as Graves' disease or toxic nodular goiter, antithyroid medications are often used. The goal with this form of drug therapy is to prevent the thyroid from producing hormones. Two common drugs in this category are methimazole and propylthiouracil (PTU) both of which actually interfere with the thyroid gland's ability to make its hormones. The illustration shows that some hormone is made, but the thyroid becomes much less efficient. When taken faithfully, these drugs are usually very effective in controlling hyperthyroidism within a few weeks. Antithyroid drugs can have side effects such as rash, itching, or fever, but these are uncommon. Very rarely, patients treated with these medications can develop liver inflammation or a deficiency of white blood cells therefore, patients taking antithyroid drugs should be aware that they must stop their medication and call their doctor promptly if they develop yellowing of the skin, a high fever, or severe sore throat. The main shortcoming of antithyroid drugs is that the underlying hyperthyroidism often comes back after they are discontinued. For this reason, many patients with hyperthyroidism are advised to consider a treatment that permanently prevents the thyroid gland from producing too much thyroid hormone.
Radioactive Iodine Treatment Radioactive iodine is the most widely recommended permanent treatment of hyperthyroidism. This treatment takes advantage of the fact that thyroid cells are the only cells in the body which have the ability to absorb iodine. In fact, thyroid hormones are experts at doing just that. By giving a radioactive form of iodine gives off a poisonous type of radiation, the thyroid cells which absorb it will be damaged or killed. Because iodine is not concentrated by any other cells in the body, there is very little radiation exposure (or side effects!) for the rest of the body. Radioiodine can be taken by mouth without the need to be hospitalized. This form of therapy often takes one to two months before the thyroid has been killed, but the radioactivity medicine is completely gone from the body within a few days. The majority of patients are cured with a single dose of radioactive iodine. The only common side effect of radioactive iodine treatment is underactivity of the thyroid gland. The problem here, is that the amount of radioactive iodine given kills too many of the thyroid cells so that the remaining thyroid does not produce enough hormone, a condition called hypothyroidism. There is no evidence that radioactive iodine treatment of hyperthyroidism causes cancer of the thyroid gland or other parts of the body, or that it interferes with a woman's chances of becoming pregnant and delivering a healthy baby in the future. It is also important to realize that there are different types of radioactive iodine (isotopes). The type used for thyroid scans (iodine scans) as shown in the picture below give up a much milder type of radioactivity which does NOT kill thyroid cells.
Surgical Removal of the Gland or Nodule Another permanent cure for hyperthyroidism is to surgically remove all or part. Surgery is not used as frequently as the other treatments for this disease. The biggest reason for this is that the most common forms of hyperthyroidism are a result of overproduction from the entire gland (Graves' Disease) and the methods described above work quite well in the vast majority of cases. Although there are some Graves' Disease patients who will need to have surgical removal of their thyroid (cannot tolerate medicines for one reason or another, or who refuse radioactive iodine), other causes of hyperthyroidism can be better suited for surgical treatment earlier in the disease. One such case is illustrated here where a patient has hyperthyroidism due to a hot nodule in the lower aspect of the right thyroid lobe. Depending on the location of the nodule, the surgeon can remove the lower portion of the lobe as illustrated on the left, or he/she may need to remove the entire lobe which contains the hot nodule as shown in the second picture. This should provide a long term cure.
Concerns about long hospitalizations following thyroid surgery have been all but alleviated over the past few years since many surgeons are now sending their patients home the morning following surgery (23 hour stay). This of course depends on the underlying health of the patient and their age, among other factors. Some are even treating partial thyroidectomy as an out patient procedure where healthy patients can be sent home a few hours post op. Although most surgeons require that the patient be put to sleep for operations on the thyroid gland, a some are even removing one side of the gland under local anesthesia with the aid of IV sedation. These smaller operations tend to be associated with fewer complaints.
A potential down side of the surgical approach is that there is a small risk of injury to structures near the thyroid gland in the neck including the nerve to the voice box (the recurrent laryngeal nerve). The incidence of this is about 1%. Like radioactive iodine treatment, surgery often results in hypothyroidism. This fact is obvious when the entire gland is removed, but it may occur following a lobectomy as well. Whenever hypothyroidism occurs after treatment of an overactive thyroid gland, it can be easily diagnosed and effectively treated with levothyroxine. Levothyroxine fully replaces thyroid hormones deficiency and, when used in the correct dose , can be safely taken for the remainder of a patient's life without side effects or complications. Just one small pill per day.