Management+Prognosis of Grave's Disease &/or Hyperthyroidism

Treatment for hyperthyroidism
Treatment of hyperthyroidism depends on the cause. In most cases, the problem causing hyperthyroidism can be cured, or the symptoms can be eliminated or greatly reduced. If left untreated, however, hyperthyroidism places undue stress on the heart and many other organs.

Beta-blockers such as propranolol help control many of the symptoms of hyperthyroidism. These drugs can slow a fast heart rate, reduce tremors, and control anxiety. Doctors therefore find beta-blockers particularly useful for people with extreme hyperthyroidism and for people with bothersome or dangerous symptoms that have not responded to other treatments.

However, beta-blockers do not control abnormal thyroid function. Therefore, they are given until other treatments bring hormone production to normal levels.
Propylthiouracil or methimazole are the drugs most commonly used to treat hyperthyroidism; they work by decreasing the gland's production of thyroid hormone. Each drug is taken by mouth, beginning with high doses that are later adjusted according to blood test results. These drugs can usually control thyroid function in 6 to 12 weeks. Larger doses of these drugs may work more quickly but increase the risk of side effects. Pregnant women who take propylthiouracil or methimazole are closely monitored, because these drugs cross the placenta and can induce goiter or hypothyroidism in the fetus. Carbimazole, a drug that is widely used in Europe, is converted into methimazole in the body.

Iodine, given by mouth, is sometimes used to treat hyperthyroidism. It is reserved for those in whom rapid treatment is needed. It may also be used to control hyperthyroidism until the person can have surgery to remove the thyroid. It is not used long-term.
Radioactive iodine may be given by mouth to destroy part of the thyroid gland. Very little radioactivity is introduced to the body as a whole but a great deal is delivered to the thyroid gland because the thyroid gland takes up the iodine and concentrates it. Hospitalization is rarely necessary. After treatment, the person should probably not be near infants and young children for 2 to 4 days. No special precautions are needed in the workplace. There are no precautions needed for sleeping with a partner. Pregnancy should be avoided for about 6 months.

Some doctors try to adjust the dose of radioactive iodine to destroy only enough of the thyroid gland to bring its hormone production back to normal, without reducing thyroid function too much; others use a larger dose to completely destroy the thyroid. Most of the time, people who undergo this treatment must take thyroid hormone replacement therapy for the rest of their lives (see Thyroid Gland Disorders: Treatment). Concern that radioactive iodine may cause cancer has never been confirmed. Radioactive iodine is not given to pregnant or nursing women, because it crosses the placenta and enters the milk and may destroy the fetus's or breastfed infant's thyroid gland.

Surgical removal of the thyroid gland, called thyroidectomy, is a treatment option for young people with hyperthyroidism. Surgery is also an option for people who have a very large goiter as well as for those who are allergic to or who develop severe side effects from the drugs used to treat hyperthyroidism. Hyperthyroidism is permanently controlled in more than 90% of those who choose this option. Hypothyroidism often occurs after surgery, and people then have to take replacement thyroid hormone for the rest of their lives. Rare complications of surgery include paralysis of the vocal cords and damage to the parathyroid glands (the tiny glands behind the thyroid gland that control calcium levels in the blood).



Additional Treatment for Grave's Disease
In Graves' disease, additional treatment may be needed for the eye and skin symptoms. Eye symptoms may be helped by elevating the head of the bed, by applying eye drops, by sleeping with the eyelids taped shut, and, occasionally, by taking diuretics (drugs that hasten fluid excretion). Double vision may be helped by using eyeglass prisms. Finally, corticosteroids taken by mouth, x-ray treatment to the orbits, or eye surgery may be needed if the eyes are severely affected. Corticosteroid creams or ointments can help relieve the itching and hardness of the abnormal skin. Often the problem disappears without treatment months or years later.





Prognosis

Up to 50% of people treated with 12 to 24 months of anti-thyroid drugs have prolonged remissions of their illness. Radioactive iodine also is an effective treatment, although most people will develop an underactive thyroid (hypothyroidism) following this treatment. However, this condition is easily treated with a single pill of thyroid replacement medication daily.

The prognosis for Graves’ disease patients is extremely favorable. Most patients respond well to treatment, but lifelong observation by a healthcare professional is important because possibly serious complications are associated with the disease. Antithyroid medications may also cause side effects. The more serious complications of prolonged, untreated, or improperly treated Graves’ disease include a weakened heart muscle, which can lead to heart failure, osteoporosis, or possible severe emotional disorders.


http://pubs.acs.org/subscribe/journals/mdd/v04/i02/html/disease.html
http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/9513.html

Chris.