Thyrotoxicosis treatment option??
A 36-year-old woman with a past medical history of fibromyalgia presented to her general physician for a regular check-up. The patient reported that her mother was recently diagnosed with hypothyroidism and requested that her scheduled blood work include thyroid function tests. The patient said she has been well; even her symptoms related to fibromyalgia had been under control. Her only complaint was some hair loss, but it had slightly improved since she began using over-the-counter supplements 3 months before her appointment. On physical examination, the patient appeared to be healthy: her vital signs were normal, there was no evidence of thyroid eye disease, tremor, or tachycardia; and her thyroid gland was not enlarged. Blood work completed the same day revealed normal complete blood count and liver and kidney function tests, but thyroid-stimulating hormone (TSH) was low, measuring 0.02 µIU/mL (reference range, 0.4-4.6 mIU/L). Free thyroxine (T4) was measured at 24 pmol/L (reference range, 10-19 pmol/L), and free triiodothyronine was measured at 7.1 pmol/L (reference range, 3.5-6.5 pmol/L). After review of her previous laboratory tests, it was found that her thyroid function tests, including TSH and free T4 levels, were previously normal on several occasions.
@minti Medication – drugs called beta-blockers (e.g. propranolol), can be used to reduce the symptoms of thyrotoxicosis such as the heart rate, anxiety or sweating. However, to treat the raised hormone levels, different medication called carbimazole or another called propylthiouracil is used. These act on enzymes in the thyroid gland to prevent production of thyroid hormones.
Patients can be treated using two different medication regimes. They can start by taking carbimazole every day with thyroid function tests regularly (every one to two months) and have the medication dose changed according to the blood test results. Alternatively, they can have treatment with both carbimazole and manufactured thyroid hormone, started at the same time.
Radioactive iodine – this involves the patient taking either a capsule of radioactive iodine. This is carried out as an outpatient. Iodine is taken up by the thyroid gland so that the radioiodine is concentrated in the gland and causes a gradual destruction of the overactive gland.
Surgery – this involves removal of all or part of the thyroid gland. This is normally only performed once thyroid hormone levels have been controlled using medication.