Treatment

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The treatment you receive depends on the type of thyroid disorder you have, what's causing it and your overall medical condition. In general, there are three categories of treatment: prescription medication, radioactive iodine and surgery (thyroidectomy).

Hypothyroidism

Hypothyroidism, including Hashimoto's thyroiditis, is the simplest of the three types of thyroid disorders to treat. It requires a daily dose of prescription synthetic T4, called levothyroxine sodium (L-thyroxine, L-T4). You and your health care professional will work together to find the right dose for you based on your symptoms and blood tests.

You'll need to take T4 for the rest of your life, although the dose may change. You will also need periodic blood tests to evaluate the dose.

Many years ago, the only treatment available for hypothyroidism was desiccated thyroid, the dried and powdered thyroid glands of animals. It contains both T4 and T3. While desiccated thyroid is still available today, few health care professionals advocate this "natural" therapy. Desiccated thyroid produces variable blood levels of thyroid hormones, not the steady and predictable levels needed for optimal health.

If your L-T4 dose is too low—if you remain somewhat hypothyroid—you run the risk of developing arteriosclerosis due to elevated cholesterol levels and may experience symptoms of hypothyroidism (depression, low body temperature, dry or itchy skin, poor memory, muscle aches, slowed reflexes, among other symptoms). If your dose is too high—if you become somewhat hyperthyroid—you may notice symptoms of hyperthyroidism (nervousness, weight loss, fast/irregular heart rate, changes in appetite, insomnia, muscle weakness/fatigue, decreased menstrual flow, among other symptoms). Over time, TH excess can increase your risk of heart attack or osteoporosis.

As of January 2007, four branded oral L-T4 products were available in the United States: levothyroxine sodium (Unithroid, Levoxyl, Synthroid and Levothroid). Several generic versions of L-T4 (levothyroxine) are also available. Because different generic versions may differ in the amount of levothyroxine they contain, many experts have expressed concerns about potential adverse effects caused by switching from branded to generic L-T4 preparations.

Generally, you should stick with one L-T4 product for treating hypothyroidism, generally a branded L-T4. However, because of insurance issues, you may not have a choice between branded or generic. If possible, stick to one generic to keep the level fairly consistent in your body. If you must change generics or brands, talk to your health care professional—he or she may have to change the dose to maintain the desired effect or prevent toxicity.

If you do switch brands or change to a generic L-T4, the American Thyroid Association recommends repeat blood tests (i.e., TSH levels) within six to eight weeks to ensure the proper dosage. In general, because multiple manufacturers produce generic versions, those on generic L-T4 should have their TSH levels monitored more frequently.

Hyperthyroidism

If you are diagnosed with hyperthyroidism, including Graves' disease, your health care professional will consider several factors to determine the best treatment for you. These include your age, your general health and the cause and severity of the hyperthyroidism. Available treatments include radioactive iodine (the type that damages thyroid tissue), antithyroid drugs and surgery.

A dose of radioactive iodine works to damage the thyroid gland, ending the hyperthyroidism. After the iodine is administered, the gland shrinks and blood levels of TH drop. Patients report feeling better within three to six weeks, and in most, the hyperthyroidism is completely resolved within six months. The main side effect is the development of hypothyroidism. Occasionally, you may develop a sore throat one or two weeks after the treatment.

Some people with hyperthyroidism receive antithyroid drugs such as propylthiouracil (PTU) or methimazole (Tapazole). These drugs are designed to interfere both with the thyroid gland's uptake of iodine and with one or more of the steps required for the thyroid to make TH. Because iodine is essential for TH production, reducing the amount of iodine the thyroid gets reduces the amount of TH it produces. About 25 percent of people with Graves' disease go into remission after one or two years of treatment, after which the drugs are stopped.

Surgery to remove part of the overactive thyroid gland is occasionally recommended to treat hyperthyroidism. Like radioactive iodine, people who undergo surgery usually become hypothyroid. Complications include damage to the parathyroid glands that control the body's calcium levels and damage to the nerves that control your vocal cords, leading to hoarseness.

Since any of the three treatments for hyperthyroidism can lead to hypothyroidism, it's important that you learn to recognize the symptoms of too little thyroid hormone: depression, low body temperature, dry or itchy skin, poor memory, muscle aches and slowed reflexes. Let your health care professional know if you experience any symptoms.

Nodules

If a nodule is benign—as most are—most of the time it simply needs to be monitored, not treated. If a biopsy is unclear, or identifies a malignancy, then you will need a thyroidectomy, or removal of all or part of the thyroid.

A thyroidectomy is performed under general anesthesia and takes about two hours. If the biopsy showed a malignancy, the surgeon usually removes the entire thyroid and some surrounding lymph nodes. If the biopsy was unclear, the surgeon may remove just one lobe of the thyroid and, while you're still under the anesthetic, wait for it to be tested for cancerous cells. If these cells are present, the surgeon removes the other lobe. If the cancer has spread outside the thyroid, the surgeon may also remove the lymph nodes in your neck.

If you have thyroid cancer you usually require treatment with a large dose of radioactive iodine about six weeks after surgery to dissolve any remaining cancerous tissue. You also begin lifelong TH replacement therapy. But the surgery and radioactive iodine generally cures the cancer.

As with other surgery, the minor risks include infection, bleeding and scar tissue on the neck. Major side effects from surgery are rare and involve complications to neck structures close to the thyroid, including damage to the parathyroid glands that control your body's calcium levels and damage to the nerves that control your vocal cords, leading to hoarseness. These complications, however, occur in less than one percent of patients operated on by experienced surgeons. If the parathyroid glands are damaged during surgery, you'll need calcium supplements and possibly other drugs.