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Treatments for Thyroid Diseases and Conditions

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From Mary Shomon,

Hypothyroidism, Hyperthyroidism, Thyroiditis, Nodules, Goiter, Thyroid Cancer

Recommended treatment approaches depend on the type of thyroid disease you have, and in some cases, the severity of the condition. This article provides an overview of the treatment approaches for key thyroid conditions, as well as information on the specific treatments.

HYPOTHYROIDISM/HASHIMOTO'S DISEASE

Hypothyroidism is a condition where the thyroid is underactive, chemically destroyed, or surgically removed, and therefore unable to produce sufficient levels of thyroid hormone. Hypothyroidism is treated by replacing the missing hormone, a hormone that is essential to the body’s key functions. This is accomplished by taking thyroid hormone replacement drugs prescribed by a physician.Some practitioners believe that Hashimoto’s requires no treatment, and will only treat a patient with thyroid hormone replacement drugs when the Hashimoto’s has resulted in hypothyroidism that can be verified through laboratory testing.

Some practitioners believe that Hashimoto’s, which can be confirmed by testing for thyroid antibodies, warrants treatment in some patients. There is some evidence that treating Hashimoto’s disease with thyroid hormone replacement drugs before the thyroid stimulating hormone (TSH) level rises may alleviate some symptoms. Some research suggests that treating someone with Hashimoto’s but a normal TSH may help prevent elevation of the TSH level and progression to full hypothyroidism. This is discussed further in Treating Hashimoto's When the TSH is Normal.

On the integrative medicine front, some holistic practitioners recommend iodine supplementation, other nutritional supplements, dietary changes, particular yoga poses, mind-body medicine, and other complementary approaches to help the thyroid.

HYPERTHYROIDISM / GRAVES’ DISEASE

Hyperthyroidism is a condition where the thyroid gland is overactive, and produces an excess of thyroid hormone. The gland becomes overactive primarily due to autoimmune Graves’ disease, or in some cases due to thyroid nodules that produce excess thyroid hormone, or viral illness.

Hyperthyroidism is treated by reducing the excess hormone levels, which is accomplished in three different ways:

  • antithyroid drugs
  • radioactive iodine treatment (RAI), also known as radioiodine ablation
  • surgical removal of all or part of the thyroid, known as thyroidectomy
  • block/replace therapy (BRT)
  • thyroid arterial embolization
The approach used for treatment depends on the severity of the condition, whether or not the patient is a child or a pregnant woman, and in some cases, the preference or perspective of the treating physician. There are also differences in approaches between the United States and other countries in terms of the treatments used. In the United States, surgery is rarely done for hyperthyroidism (except for pregnant women), and RAI is the treatment of choice, to the extent that some patients may not even be informed that antithyroid drugs or surgery are options. In Europe, however, antithyroid drug therapy is likely to be a practitioner’s first choice for treatment.

Interest is also growing in thyroid arterial embolization, a new approach for Graves' disease treatment.

In some cases, key hyperthyroidism symptoms such as rapid heart rate or elevated blood pressure are also treated with drugs known as beta-blockers.

Most thyroid patients who receive RAI treatment or have surgery eventually end up hypothyroid, and are treated with thyroid hormone replacement drugs.

Some integrative practitioners recommend stress reduction programs, antithyroid dietary and nutritional changes, traditional Chinese medicine, and other holistic approaches to help an overactive thyroid.

THYROID STORM

Thyroid storm is a rare but potentially life-threatening complication of hyperthyroidism. When this condition is suspected, immediate treatment needs to be obtained at an emergency room.

THYROIDITIS

Thyroiditis refers to an inflammation of the thyroid. While autoimmune (Hashimoto’s) thyroiditis is common, there are other forms of thyroiditis, including post-partum thyroiditis, De Quervain's (also called subacute or granulomatous) thyroiditis, and viral thyroiditis, among others.

As noted, in some cases, Hashimoto’s thyroiditis is treated with thyroid hormone replacement drugs. For cases of thyroiditis that are painful, doctors typically recommend a pain-reliever with anti-inflammatory properties, such as aspirin, ibuprofen (Advil/Motrin), or naproxen (Aleve).

If the thyroiditis is especially acute, doctors occasionally recommend steroid drugs to reduce inflammation, along with thyroid hormone replacement drugs, to allow the thyroid to rest from its job of hormone production.

Holistic practitioner Stephen Langer, M.D., has shared his recommendations regarding nutritional supplements helpful in treating thyroiditis.

On the nutritional front, there is some evidence that supplementing with the mineral selenium may help thyroiditis.

GOITER

A goiter is the term used for an enlarged thyroid. Goiter can develop in both hypothyroidism and hyperthyroidism.

A goiter can cause a variety of symptoms, including a feeling of fullness in the neck, pain, and less commonly, may wrap around the trachea, making it difficult to swallow or even breathe.

Doctors may decide to monitor -- not treat -- a small goiter that is not causing symptoms.

For a small, symptomatic goiter, doctors typically treat with thyroid hormone replacement drugs. The drugs can slow down or stop the growth of the goiter in some cases, but they don’t typically shrink the goiter.

If the goiter is large, continues to grow while on thyroid hormone, is cosmetically unsightly, or symptoms continue or worsen, doctors may recommend radioactive iodine (RAI) to shrink the gland, or surgery to remove it all or in part.

In some cases, goiter can be due to iodine deficiency, in which case, doctors may recommend use of iodine supplementation.

THYROID NODULES

Nodules can be malignant (cancerous), benign, or indeterminate. The screening process, which involves blood tests, imaging tests, and typically, helps to identify whether a nodule is cancerous. When the biopsy is indeterminate, many patients choose to get a second opinion on thyroid nodules.

The thyroid is almost always surgically removed all or in part when cancerous or indeterminate nodules are detected. In the case of malignancy, thyroid cancer treatment protocols are followed, based on the type of cancer detected.

For small, benign nodules that cause no symptoms, many practitioners prefer to monitor patients. A substantial percentage of the population – some experts suggest the majority of people – have these asymptomatic nodules, and require no further treatment.

For symptomatic benign nodules, the first course of treatment is frequently the thyroid hormone replacement drug levothyroxine, which can sometimes shrink the nodule, prevent nodules from growing, and help prevent more nodules from forming. Because the treatment is fully effective in only a minority of patients, levothyroxine therapy is considered somewhat controversial.

If the benign nodule is larger and unresponsive to drug or radioactive iodine treatment, surgery is often recommended.

Another approach being used for nodules is Percutaneous Ethanol Injection (PEI), where the nodule is shrunk by an injection.

Another promising new non-surgical technology for nodules is high-intensity ultrasound beam technology.

Detailed guidelines on treatment for nodules are featured in the American Association of Clinical Endocrinologists’ Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules.

THYROID CANCER

There are four different types of thyroid cancer: papillary, follicular, medullary, and anaplastic. The treatments are based on the type of cancer, and in some cases, the staging -- how far the cancer has spread to other parts of the body -- as well as if it’s a new cancer or a recurrent cancer.

The treatments for thyroid cancer include:

  • Surgery to remove the cancer, known as a thyroidectomy. Some patients receive a lobectomy, which removes only one side of the thyroid. A near-total thyroidectomy removes almost all of the gland. The entire thyroid is removed in a total thyroidectomy. Lymph node dissection is also sometimes performed during thyroid surgery, to assess the spread of thyroid cancer.

  • Radiation therapy to kill cancer cells. Radiation can be delivered outside the body (known as external beam radiation) or by radioactive iodine (RAI), which is usually administered as a liquid or pill. The thyroid absorbs iodine, and the radioactive form of iodine collects in thyroid tissue and kills cancer cells.

  • Hormone therapy, using thyroid hormone replacement drugs. Administering thyroid hormone, usually at suppressive doses to keep TSH low or undetectable, helps prevent thyroid cancer from recurring, by suppressing the activity of any residual thyroid tissue.

  • Chemotherapy, which uses drugs to kill cancer cells. It may be taken in pill form, or intravenously.
Early stage papillary and follicular thyroid cancer is treated by surgery to remove all or part of the thyroid, followed by hormone therapy and, in some cases, radioactive iodine. If the papillary or follicular cancer is later stage, lymph node dissection, or external-beam radiation therapy may be added to the treatment. In late stage papillary or follicular thyroid cancer, clinical trials of specialized chemotherapy drugs may also be recommended.

Treatment for medullary thyroid cancer typically includes total thyroidectomy, and in some cases, lymph nodes are also removed. In the later stages of medullary thyroid cancer, radiation therapy to shrink tumors is used to help relieve symptoms and improve quality of life. In late stage medullary cancer, chemotherapy may be recommended to help relieve symptoms.

Treatment for anaplastic thyroid cancer can include the following: tracheostomy surgery to create an opening in the windpipe (done for tumors that interfere with breathing); total thyroidectomy to reduce symptoms; external-beam radiation therapy; chemotherapy; and clinical trials studying new therapies.

Some new therapies for thyroid cancer are currently in investigational or trial status, including the drug axitinib, combretastatin, and lenalidomide.

Detailed guidelines on treatment of thyroid cancer are featured in the Thyroid Cancer Guidelines from the American Thyroid Association (2006).

Mary Shomon, About.com's Thyroid Guide since 1997, is a nationally-known patient advocate and best-selling author of 10 books on health, including "The Thyroid Hormone Breakthrough: Overcoming Sexual and Hormonal Problems at Every Age," "The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss," "Living Well With Hypothyroidism: What Your Doctor Doesn't Tell You...That You Need to Know," "Living Well With Graves' Disease and Hyperthyroidism," "Living Well With Autoimmune Disease," and "Living Well With Chronic Fatigue Syndrome and Fibromyalgia." Click here for more information on Mary Shomon.

source:about.com



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