Method of treatment

I will treat you so that thyroid hormone is not made too much. There are 3 ways of internal medicine treatment (antithyroid drug, occasionally iodine), radioactive iodine treatment (isotope), surgery. Which method you choose depends on the person’s condition, age, social situation, etc.

Medication treatment
It is a method of regularly taking medicine (antithyroid drug) that suppresses the synthesis of thyroid hormone. Depending on the condition of each patient, if you take the right amount of medicine, the concentration of thyroid hormone in the blood will be normal in 1 to 3 months. If you do so, you will be able to take symptoms of symptoms and you will be able to live a life that is no different from ordinary people.
The most important thing in medicine treatment is to take an appropriate amount of medicine while periodically measuring the amount of thyroid hormone. If patients with Graves’ disease are mildly ill, the required amount of antithyroid drugs will decrease. If the thyroid function is kept normally for more than half a year from 1 tablet a day to 2 days a day, we will consider stopping the antithyroid drug. In our hospital grades, about 40% was able to stop medicine in about 3 years.

[Side effects of antithyroid drug (mercazole, thiurazir (propargyl))]
(1) itching, eruption
It takes 2 to 3 weeks after taking medicine. If it happens after months, it is due to other causes. Frequency is about 1 in 10 people.
If itching only, it may disappear if it is taken lightly with the itching stop if it is light.
If you have a red rash, it seems better to stop the medication. In severe cases, inflammation may occur even to the esophageal mucosa or heat of about 39 ° C may be accompanied.

(2) abnormal liver function
Even with hyperthyroidism alone, abnormalities may be seen in liver examination, but in this case it will fit as long as thyroid function is normal by taking medicine.
In the case of side effects of medicine, it will occur from about 2 weeks to about 3 months after starting drinking. It is divided into two types, AST, ALT type only and type with jaundice. It seems that it is often found in thiurazir (propargyl) rather than mercazole. If type of jaundice occurs or AST, ALT becomes considerably high, discontinuation is necessary, but if mild liver dysfunction is temporarily observed, continuation of antithyroid drugs is sometimes possible.

(3) agranulocytosis
It is a side effect that cells that kill bacteria called leukocytes are lost. Frequency is one in 1000 people. It is rare that it happens within 2 to 3 months since I started taking medicine, but please be careful as it may happen after that. This is a very dangerous side effect, sometimes it is life-threatening if left unattended. Because symptoms are strong sore throat and high fever, it is necessary not to leave it merely as a cold. In order to diagnose, it is necessary to examine the number of granulocytes by urgent blood test.

(4) Other rare side effects
Arthralgia may occur with fever within 2 to 3 weeks after taking medicine. This joint pain changes in mobility and pain, but it is mainly found in the joints of the upper and lower limbs.
In addition, it can be seen in patients taking thiurazir (Propargil), but inflammation may occur in blood vessels of kidneys and lungs. This side effect may require bleeding from the lungs in severe cases or cause renal failure and dialysis. With this side effect, the antibody called P – ANCA will be positive by blood test. Also, this side effect may occur several years after taking the medicine, so always be careful while taking medicine.

■ Isotope (radioactive iodine) treatment
Taking radioactive iodine and reducing the number of thyroid cells by the action of radioactive iodine gathered in the thyroid gland. As the number of thyroid cells decreases, the amount of secreted thyroid hormone decreases as well. Thyroid hormone secretion decreases approximately 2 to 6 months after taking radioactive iodine capsule. It is a good thing about this method to heal swelling faster than medicine as the swelling of the neck shrinks as it does not have scratches like surgery.
The disadvantage, however, is that even if treated in the same way, the cells are too reduced and conversely the thyroid function may be reduced. In the treatment method at our hospital, in 5 years after treatment, about 30% of people suffer a decrease in function. Unfortunately, it is hard to prevent this completely.
But thyroid function decline can be easily controlled if thyroid hormone medication is taken. The thyroid hormone drug itself has no side effects, it is much easier and more secure than suffering from hyperthyroidism.

[Side effects due to isotope treatment]
It seems that there are many people who worry about side effects such as cancer only by giving a name of radioactive. However, it is statistically proven that there is no such worry with the amount used for treatment. Moreover, it is said that there is no influence on descendants, and in the United States, 70% of Graves’ disease patients excluding special circumstances such as pregnancy / nursing are treated with isotope It is being done.

[Isotope treatment and eye symptoms]
It is reported that the symptoms of the eye deteriorate by about 1% caused by isotope treatment. It is necessary to evaluate whether it is possible to treat isotope by ophthalmologic examination (examination, MRI examination) before treatment.
It is a picture to introduce about isotope treatment of Graves’ disease in Ito Hospital.

■ Surgical Therapy
It is a method of surgically resecting the thyroid gland secretion hormone excessively.
In order to rectify overproduction of hormones by resecting the thyroid gland which is the secretion source of the hormone.
Basically it is done with general anesthesia.

The ideal goal of surgical therapy is “normalization of thyroid function without requiring internal medicine”.
In order to pursue this ideal, once used “standard thyroidectomy” as a standard method. Subtexectomy is the method of leaving the proper amount of thyroid gland and resecting the remaining thyroid glands.
However, if the amount of thyroid to be left is large, hyperfunctionis recurs, and if it is low, it becomes hypofunction. Moreover, since the appropriate amount of thyroid gland differs for each patient, it is difficult to predict the proper amount to remain before surgery. To some extent, we have been studying and studying for a long time at our hospital to explore the proper amount of thyroid gland, but unfortunately we are not yet able to realize it. Therefore, only about 30% of patients who have thyroid function completely normal after this subtotomy are normal.
On the other hand, recurrence of hyperactivity was observed in about 20% of patients. Since recurrence may occur after many years of surgery, examination is necessary throughout the lifetime. We were concerned that there are few recurrences. If it recurs at the milestone of life such as examination, employment, pregnancy, childbirth, it may cause undesirable results.

Currently, our hospital recommends resecting all or nearly all of the thyroid to patients who require surgical therapy. This surgical procedure will not cause recurrence after surgery, but on the other hand all patients suffer from hypothyroidism, so it is necessary to take thyroid hormone medication orally.
There may be resistance to continuing to drink thyroid hormone medicine, but there is less burden to the mind and body than hyperfunction, and if the amount to be administered is decided thyroid function becomes constant and physical condition also It will stabilize. There is no need to worry about side effects, prescription of long term (6 months at our hospital) is also possible, so the number of hospital visits will be reduced.
In addition, it can be expected to reduce “anti – TSH receptor antibody” which is the cause of Graves’ disease of neonates as soon as possible, compared with subtotal cystectomy, and childbirth is also safe.

According to this policy, the attending physician would recommend patients to resect all or nearly all thyroid glands, but some patients still desire traditional subtotal surgery. It is important to know the advantages and disadvantages of each surgical method well and think about it taking into consideration the patient itself.
It is best to select a method that suits each patient, after consulting with your doctor.

How to choose a treatment method
As mentioned above, there are advantages and disadvantages to each of the three cures. In addition to its characteristics, how to throw the thyroid gland, the thyroid stimulating antibody in the blood, etc., the treatment method will be selected considering the patient’s life, desires, age and so on. Therefore, patients themselves also think about the strengths and weaknesses of treatment, and I think that we should think about which method is most appropriate for ourselves together with us.