Treatments for Graves' Disease

Wednesday, 29 Jun 2011 03:59 PM

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No treatment for Graves’ disease will halt the production of the antibodies responsible for the condition, but medication can help to reduce levels of thyroxine and control symptoms.

Medications which are typically prescribed to patients with Graves’ disease include:

• Beta Blockers: Used to block some of the action of thyroxine, these medications will often alleviate symptoms like rapid heart rate, nervousness, and tremors. Examples of beta blockers are propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor), and nadolol (Corgard).
• Anti-thyroid medications: Medications like propylthiouracil and methimazole (Tapazole) prevent the thyroid from overproducing hormones. Anti-thyroid medicine is typically used for at least a year and can put Graves’ disease into long-term remission, although relapse is possible. These drugs are often used in tandem with radioactive iodine treatment or thyroid surgery. The two medications named above can cause serious, and sometimes fatal, liver damage.
• Radioactive iodine treatment: Iodine is a necessary component for the production of thyroid hormone. When you take radioactive iodine, it collects in the thyroid gland and, over time, the radioactivity destroys overactive thyroid cells. The thyroid gland will shrink, and complications resulting from a defective thyroid will typically fade over weeks or months. Patients who choose this form of therapy often need thyroxine treatment to supply the body with normal amounts of the hormone. It should be noted that radioactive iodine may cause or worsen Graves’ ophthalmopathy, although this side effect is generally mild or temporary.

People with eye problems should not opt for this treatment.
Surgery to remove the thyroid gland is also an option for Graves’ sufferers who cannot tolerate anti-thyroid medication or radioactive iodine treatment. After the surgery, patients will likely require thyroxine treatment to maintain normal levels of thyroid hormones. A thyroidectomy may lead to damage of the vocal cords and parathyroid glands, which control the body’s calcium levels. Complications from this surgery occur rarely under the care of an experienced thyroid surgeon.

Separate treatments exist for Graves’ ophthalmopathy, a condition of the eyes caused by Graves’ disease. Mild symptoms can be treated with eye drops or lubricating gels, but more severe symptoms can be controlled with:

• Medication: Prescription corticosteroids like prednisone can reduce swelling of the tissue behind the eyes
• Orbital decompression surgery: During this operation, a doctor removes the bone that separates the eye socket from the sinuses. Without this bone, the eyes are free to move back to their original position. Patients who choose this surgery may develop double vision or numbness in the lips.
• Eye muscle surgery: Inflammation in the eyes’ muscles caused by Graves’ disease shortens the muscles and prevents the eyes from aligning properly. During this surgery, the eye muscles are detached from the eyeballs and then reattached farther back. More than one surgery may be needed.
• Prisms: Prisms in a pair of eyeglasses may help to remedy double vision caused by Graves’ disease or a surgery to correct Graves’ ophthalmopathy.
• Orbital radiotherapy: Once a common treatment for Graves’ ophthalmopathy, orbital radiotherapy uses targeted X-rays over the course of several days to destroy some of the tissue behind the eyes. Some studies show that this method of treatment is not effective for patients with more severe Graves’ ophthalmopathy, but will likely be recommended if eye problems are worsening and medication is not working.

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