Treatment of hyperthyroidism in women

With the continuous improvement of living standards, the incidence of thyroid diseases is also very high. Especially for many women, hyperthyroidism is a disease that is very harmful to the body and seriously affects the health of the body. It always makes women have a rapid heartbeat or a thick neck. If not treated in time, it may even make women's eyes bulge outward. This not only affects health but also their own image. Let's learn about the treatment methods of hyperthyroidism in women.

Treatment of hyperthyroidism in women

Medication

There are currently three main methods for treating hyperthyroidism: medical drug therapy, 131I radiotherapy and surgical treatment. Among the elderly, medical drug treatment is the most basic method, and 131I radiotherapy is also relatively commonly used. Due to physical conditions, surgery is relatively less used among the elderly.

Internal medicine treatment

The main drugs for the treatment of hyperthyroidism are thiourea drugs, including thiouracil and imidazole. Commonly used drugs in China include methimazole (thimazole), propylthiouracil (PTU), carbimazole (which breaks down into thimazole in the body to take effect) and methylthiouracil (MTU). The latter is now rarely used. The mechanism of action of thiourea drugs is mainly to inhibit the activity of thyroid peroxidase, block tyrosine iodination, and thus inhibit the synthesis of thyroid hormones.

The drug treatment process can be roughly divided into 3 stages:

(1) Symptom control stage: generally takes 1 to 3 months, the dosage is generally 30 to 40 mg of methimazole (thimazole) or 300 to 400 mg of propylthiouracil (PTU) per day, taken in 3 to 4 times. To alleviate symptoms, especially rapid heart rate, beta-receptor blockers such as propranolol (Inderal) can be added. Most patients need to take propranolol-type drugs in the first 2 to 4 weeks of treatment because antithyroid drugs have not yet taken effect.

(2) Drug dose reduction phase: generally takes 2 to 3 months. When the clinical symptoms are basically relieved and the thyroid function tests TT3, FT3, TT4, and FT4 return to normal, you can start reducing the medication. The first dose reduction can generally reduce the daily dose by 1/3. Later, while maintaining clinical symptom relief and normal thyroid function, most patients can reduce the dose once a month or so, with each reduction in daily dose being 5 mg of methimazole (thimazole) or 50 mg of propylthiouracil (PTU).

(3) Maintenance phase: The maintenance dose is generally 5-15 mg of methimazole (thimazole) or 50-150 mg of propylthiouracil (PTU) per day. Most patients receive 5 mg of methimazole (thimazole) or 50 mg of propylthiouracil (PTU), twice a day. If the maintenance dose is too small, the recurrence rate of hyperthyroidism will increase. During this stage, thyroid powder (tablets) or levothyroxine should continue to be taken. In principle, the dosage remains unchanged until the medication is stopped.

131I radiotherapy

This method is a convenient, safe and effective way to treat hyperthyroidism, and is especially suitable for the elderly. After the patient takes an appropriate amount of 131I, it is quickly absorbed by the thyroid gland. The rays emitted by 131I during the decay process, mainly alpha rays, produce internal irradiation to the cells, destroying the thyroid cells and achieving the purpose of hypothyroidism.

Avoid iodine within 2 weeks before taking 131I. Calculate the dose of 131I based on the size of the thyroid gland and the iodine absorption rate, and take it all at once. Generally, hyperthyroidism symptoms begin to ease 2 to 3 weeks after taking the medication, and are relieved in 1 to 3 months. If necessary, a second treatment can be considered after 6 to 9 months. Patients with severe hyperthyroidism can take antithyroid drugs and propranolol 1 to 7 days after taking 131I. The domestic reported cure rate is over 80%, and the overall effective rate is over 95%. The main complication of this treatment is hypothyroidism. Temporary hypothyroidism caused 3 to 6 months after treatment can be recovered within 1 year; the incidence of permanent hypothyroidism increases with the extension of time after treatment. Foreign statistics show that 20% of patients develop hypothyroidism in the first two years of treatment, and the average annual incidence thereafter is 3.2%. Domestic literature reports that the incidence of hypothyroidism is mostly lower than that in foreign countries, but there are also reports that followed up 748 patients and found that the cumulative prevalence had reached about 50% 11 years after treatment. The cause of permanent hypothyroidism is related to the radiation dose and the individual's sensitivity to radiation, and the presence of autoantibodies TGAb and TMAb cannot be ruled out.

A small number of people experience shortness of breath and thyroid pain 2 to 3 days after taking 131I. Occasionally, there is a concurrent hyperthyroid crisis. Therefore, during the first week of treatment, you should pay close attention to changes in the condition.

Surgery

Subtotal thyroidectomy is also an effective treatment for hyperthyroidism. Indications for surgery are:

(1) The thyroid gland is significantly enlarged (grade III or above), with obvious vascular murmurs, and the thyroid gland does not shrink significantly after medical treatment.

(2) Nodular goiter or toxic adenoma.

(3) The effect of medical treatment is not ideal and the disease relapses frequently.

(4) Those who have difficulty with or have difficulty adhering to long-term drug treatment. The patient must undergo antithyroid drug treatment, and the thyroid function (mainly TT4, FT4, TT3 and FT3) must return to normal. Then, the patient must undergo adequate preoperative preparation, including taking Lugol's solution 3 times a day, 10 drops each time, and surgery can only be performed 2 to 3 weeks later. Antithyroid drugs can be taken until 5 to 7 days before surgery and then discontinued. 90% of patients can achieve satisfactory results with surgical treatment. But it can still recur after surgery. A small number of patients may also develop hypothyroidism, especially after Hashimoto's hyperthyroidism surgery. Therefore, surgical treatment is generally not suitable for such patients. Surgical treatment should be contraindicated for patients who cannot tolerate surgery due to their general condition, infiltrative exophthalmos, and hyperthyroidism caused by various thyroiditis. Elderly patients with hyperthyroidism have poor physical conditions and are often accompanied by chronic diseases such as coronary heart disease, poor cardiopulmonary function, and hypertension. The risk of surgery is increased, so surgical treatment should be performed with caution.

Hyperthyroid heart disease should be treated with medical drugs or 131I radiotherapy, and surgery should be contraindicated. The principle of treating hyperthyroidism is mainly to effectively control hyperthyroidism. After hyperthyroidism is controlled, the heart condition can mostly return to normal or improve significantly. However, the elderly often have organic heart diseases such as coronary heart disease and cor pulmonale. Therefore, whether the changes in heart disease can be completely restored to normal depends on the basic condition of the heart. In the treatment of hyperthyroid heart failure, in addition to the use of cardiotonic drugs such as digoxin, beta-receptor blockers, such as propranolol (Inderalol) and atenolol (Atenolol), etc., can be used appropriately to achieve good results.

The above is an introduction to the treatment methods for hyperthyroidism in women. We know that there are many ways to treat hyperthyroidism, and surgery is not the only treatment. However, we should listen more to the doctor's opinions during treatment. In addition, if symptoms such as thirst and rapid heartbeat occur, we should check in time. Generally, it is easier to recover if the disease is treated in the early stages, and it will not cause too much pain.