Thyroid Problems and its Treatment

Antithyroid Drugs

In young people with diffuse goiter of moderate size, there is much in favor of a long-term trial of antithyroid drug therapy. If successful, normal health and normal thyroid function may be restored. About 50 per cent may expect a long-lasting remission. If the response is satisfactory the treatment should be adequate and long enough, from one to two years or longer. A favorable response may be indicated in most instances by reduced pulse rate, increase in weight, and return of well­being feelings.

Treatment should be stopped in those patients who experience adverse reactions to antithyroid drugs, such as skin wheals, (urticaria), loss of head hair (alopecia), or marked drop in the white blood cell count (agranulocytosis). Blood counts should be performed regularly at monthly intervals and a drop to less than 50 per cent of the initial white blood cell count should serve as a warning. Only a few patients are adversely sensitive to propylthiouracil or methimazole, the antithyroid drugs of choice.

Surgery

It is the considered opinion of the author that surgery should be reserved for those patients who are unable to cooperate on a program of long-term therapy or for whom it is economically unsound; it should be reserved for patients with very large goiters and particularly those with adenomatous goiters.

The operation is an elective procedure to be undertaken only in patients who have been adequately prepared by drug treatment. The toxic patient must be restored to a more normal state prior to surgery by antithyroid drugs, and then two or three weeks of treatment with potassium iodide before the operation is added to the program. With such preparation, the operation is attended by few risks and the possibility of thyroid “storm” or crisis is avoided.

Radioactive Iodine

Radioactive Iodine has become the treatment of choice of most physicians for the elderly patient. Children and pregnant women are not suitable candidates for this form of therapy.

In the pregnant woman, radioactive iodine may damage the thyroid gland of the unborn child. In children, radioactive iodine therapy is proscribed because infants and children are quite susceptible to carcinogenic effects of radiation.

The greatest problem in treatment is selection of a dose of radioactive iodine, contained in water and drunk as a “cock­tail”, which will destroy enough but not all of the gland, and restore to normal the amount of hormone produced and released. In treatment, several small doses of two to three millicuries of radioactive iodine are administered two to four months apart, depending on need. In this manner excessive amounts are avoided.

General Considerations

The patient with a thyrotoxic condition needs rest, a quiet environment, good dietary intake, vitamin supplements, and some sedation before surgery and after. Reserpine may be employed to great advantage to help relax the overanxious patient and slow the pulse rate.

EXophthalmos, or bulging eyes, may be a prominent sign in Graves’ disease. This may disappear or be reduced considerably with adequate management of the thyrotoxicosis. In some individuals the exophthalmos worsens in spite of treatment, and others who had minimal signs may develop severe exophthalmos following surgery. Treatment is difficult once severe or malignant exophthalmos has developed. Radiation of the pituitary gland has been used successfully in a few instances. Decompression operations which remove the posterior part of the bony eyeball socket are sometimes necessary to save vision. In the milder forms, diuretics, sleeping in a semi-recumbent position, tranquilizers, or cortisone-like hormones have been employed with some degree of success.

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