When Levothyroxine Doesnt Do The Job After Graves Disease
People who develop Graves disease ;because of an autoimmune disorder make too much thyroid hormone. This is diagnosed as hyperthyroidism. Symptoms include: hand or finger tremors, anxiety, weight loss, sweating, frequent trips to the bathroom, and palpitations. A common treatment for Graves disease is surgical removal of the thyroid gland. But people must have thyroid hormone to survive. That frequently leads to a prescription for levothyroxine. It doesnt always solve the problem.
What Is The Treatment For Graves’ Disease Can It Be Cured
You have three treatment options: medicine, radioiodine therapy, and thyroid surgery. Radioiodine therapy is the most common treatment for Graves’ disease in the United States, but doctors are beginning to use medicine more often than in the past. Based on factors such as your age, whether you are pregnant, or whether you have other medical conditions, your doctor may recommend a specific treatment and can help you decide which one is right for you.
Thyroid Surgery For Graves’ Disease And Graves’ Opthalmopathy
The aim of this review was to compare different surgical techniques for treatment of Graves’ disease. We wanted to address whether surgically removing the whole thyroid gland is better than removing most of the gland at controlling increased activity of the thyroid and eye symptoms associated with Graves’ disease.
Graves’ disease is a common condition affecting the thyroid gland, which has an important role in controlling the body’s metabolism. The body’s own immune system attacks the thyroid gland and causes it to work much harder. This overactivity can lead to increased risk of heart attacks and strokes if left untreated for a long period of time. Graves’ disease also causes protrusion of the eye and may limit eye movement . Graves’ disease is generally treated by medication alone or sometimes with radiation or surgery. In recent years, there has been increasing interest in surgery for Graves’ disease and other thyroid problems, as results of surgery and health-related quality of life outcomes appear promising. However, there is controversy over which surgical technique is best, as total thyroidectomy may give better control of disease long term, compared with subtotal thyroidectomy, but carry a greater risk of postoperative complications, such as damage to the so-called recurrent laryngeal nerve .
Quality of the evidence
Currentness of evidence
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Summarized By Susan E Calico
A woman with Graves disease faces difficult choices when she considers pregnancy. Though the fetus is at far more risk than the mother, both may be temporarily or permanently affected by her condition and its treatments.
Unfortunately, there is no way to monitor or predict the effect on the fetus of any treatment given to the mother. The few studies on Graves pregnancies are so few and small that the results are inconclusive. Even after birth, neither infant appearance nor blood tests are conclusive predictors of the childs future.
Risks of Pregnancy
The first precaution is to normalize the mothers condition before conception. Women using anti-thyroid drugs should establish a stable maintenance dose of PTU. For women treated with surgery or radioactive iodine, replacement thyroid hormone dose should be stabilized. Waiting six months after radioactive iodine treatment to conceive minimizes the effects of the radiation on developing eggs.
But the child can be affected even when the mothers Graves is well under control. No matter how long ago they were diagnosed and treated, most women with a history of Graves have measurable levels of thyroid-stimulating antibodies present in their blood.
Poorly Monitored Graves
Though neither synthetic replacement hormone nor the mothers natural thyroid cross the placental barrier, too much or too little can have serious indirect affects on the fetus. Hypothyroidism causes prolonged gestation and underdevelopment of the fetus.
What Type Of Thyroid Surgery Am I A Candidate For
Conventional thyroid surgery is done through an incision in the front of the neck. The size of the incision depends on factors such as how large your thyroid is and whether the surgeon needs to remove lymph nodes.
If your thyroid isnt very large, and no lymph nodes are involved, you may be a candidate for minimal-access surgery. Said Roman, We use a small incision, which minimizes the scar. The incision is directly over the thyroid, making it easy for the surgeon to access the gland.
Another approach is robot-assisted surgery. The surgeon controls a robotic system that directs the movements of small instruments inserted into an incision under your arm. Using the systems high-definition 3-D vision technology, the surgeon guides the instruments under your skin to your thyroid, avoiding a neck scar. Duke endocrine surgeon Dr.;Michael Stang, MD, has extensive experience with this technique. Some patients are candidates for this procedure, as long as the thyroid isnt too big, said Stang. However, if its thyroid cancer and its too advanced or has spread beyond the thyroid, then a conventional surgical approach is best.
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How Long Will It Take To Recover
Everyone is different, and recovery times may vary. In general, most people will experience a sore throat for a few days after surgery. You may find a softer diet easier to swallow during this period. For the first week, your energy level will be lower than usual as your body is using your energy to heal. Be prepared to take naps.
When My Thyroid Levels Return To Normal Will The Bags Beneath My Eyes Disappear
I’m 21 and I have hyperthyroidism, I’ve tried creams and remedies to no avail. I’ve made an appointment to have my thyroid checked again and I was on Tapazole for about a year and then my hyperthyroidism turned into hypothyroidism before being removed off the medicine. Also, I never did see an improvement with the bags under my eyes while on the medicine but I’m hoping you’ll say there’s hope that they’ll go away on their own if my thyroid is and stays normal.
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What Are The Symptoms Of Graves’ Disease
Early in the course of Graves’ Disease, the symptoms may be similar to other conditions and may delay or confuse the diagnosis.
The following are a list of the more common symptoms of Graves’ Disease:
- Unexplained weight loss
- Even though your appetite may be excessive
- Heat intolerance or excessive sweating
- Anxiety, Tremors, Restlessness
- Rapid or irregular heart rate, palpitations or chest pain
- Difficulty breathing or shortness of breath
- Goiter or thyroid mass
- Increased frequency of bowel movements
What Are The Treatments For Graves’ Disease
If you have Graves’ disease, or even suspect that you have it, you should have a professional diagnosis and, if necessary, a treatment plan that suits your particular condition. Although the disorder is rooted in a malfunctioning immune system, the goal of treatment is to restore thyroid hormone levels to their correct balance and to relieve discomfort.
Conventional Medicine for Graves’ Disease
Beta-blockers such as atenolol , propranolol , and metoprolol , frequently prescribed to treat heart disease and high blood pressure, are also used by most patients to alleviate the heart palpitations and muscle tremors that characterize Graves’ disease. Before prescribing beta blockers for this condition, however, your doctor needs to know if you are asthmatic or have any kind of heart trouble. These drugs aren’t a cure; instead they are given to block some of the effects of thyroid hormones. They are used in conjunction with other treatments.
The two most frequently used treatments involve disabling the thyroid’s ability to produce hormones.
It should be noted that most people become hypothyroid after taking radioactive iodine for Graves’ disease. If this occurs, you will have to take thyroid replacement medication for the rest of your life.
Some degree of eye complaints occur in 25%-50% of those that develop Graves’ disease but most can be managed with the home remedies discussed below. Surgery is rare and reserved for those with severe symptoms.
Home Remedies for Graves’ Disease
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What Causes Thyroid Eye Disease
TED is usually associated with systemic hyperthyroidism or Graves’ disease. This disease is caused by what is described as an autoimmune process. Autoimmune disease may be understood as a process by which the body sees some part of itself as being foreign and reacts to it much the same way that it would to any bacteria or virus.
In the case of Graves’ disease, the body sees the thyroid gland as the foreign object and produces antibodies that attack the thyroid gland. This often causes the thyroid gland to become over active.
The eye version of this disease is called Thyroid Eye Disease. However, in the case of TED, different antibodies attack the muscles associated with eye and eyelid movement. Although the thyroid gland and the eye may be under attack by the same immune system, it is felt that both conditions remain mostly independent of one another. The antibodies that attack the eye can cause inflammation and swelling of the fat and muscles around the eye, which is what can eventually cause bulging of the eyes, double vision and retraction of the eyelids.
Will my eyes go back to normal after treatment?
Thyroidectomy Recovery Stories From 3 Different Patients
- Sometimes;thyroid nodules, a goiter, or an enlarged thyroid need to be surgically removed if the growth affects breathing or swallowing. Rarely, an enlarged thyroid may be removed if it is cosmetically undesirable.;
- Some people with a toxic nodule, a goiter, or Grave’s disease have hyperthyroidism when too much thyroid hormone is produced and released. One of the treatment options considered for this type of hyperthyroidism includes surgical removal of the thyroid gland.
- A small percentage of people are born without a thyroid gland or with;a malformed thyroid, a condition known as;congenital hypothyroidism.
There are other situations in which the thyroid gland is not completely absent, but the function is so severely diminished that the underactivity is below the levels expected from standard hypothyroidism.
These conditions include:;
- Radioactive iodine ;treatment for hypothyroidism for Grave’s disease is known as ablation therapy. RAI greatly impairs and may completely destroy your gland’s ability to produce thyroid hormone, leaving you hypothyroid.
- Hashimoto’s disease is an autoimmune condition in which antibodies gradually destroy your thyroid’s ability to produce hormones.;
- Medications, such as lithium, can damage your thyroid’s ability to produce thyroid hormone.
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What Causes Hyperthyroidism
Hyperthyroidism has several causes, including
- Graves’ disease
- one or more thyroid nodules
- thyroiditis, or inflammation of the thyroid gland
- ingesting too much iodine
- overmedicating with synthetic thyroid hormone, which is used to treat underactive thyroid
Rarely, hyperthyroidism is caused by a pituitary adenoma, which is a noncancerous tumor of the pituitary gland. In this case, hyperthyroidism is due to too much TSH.
Graves’ disease, also known as toxic diffuse goiter, is the most common cause of hyperthyroidism in the United States. Graves’ disease is an autoimmune disease, which means the body’s immune system acts against its own healthy cells and tissues. In Graves’ disease, the immune system makes an antibody called thyroid stimulating immunoglobulin , which mimics TSH and causes the thyroid to make too much thyroid hormone.
Thyroid nodules, also called adenomas, are lumps in the thyroid. Thyroid nodules are common and usually noncancerous. About 3 to 7 percent of the population has them.;However, nodules may become overactive and produce too much hormone. A single overactive nodule is called a toxic adenoma.
When multiple nodules are overactive, the condition is called toxic multinodular goiter. Often found in older adults, toxic multinodular goiter can produce a large amount of excess thyroid hormone.
Overmedicating with Thyroid Hormone
Reasons For Thyroid Surgery
The most common reason for thyroid surgery is the presence of nodules or tumors on the thyroid gland. Most nodules are benign, but some can be cancerous or precancerous.
Even benign nodules can cause problems if they grow large enough to obstruct the throat, or if they stimulate the thyroid to overproduce hormones .
Graves disease causes the body to misidentify the thyroid gland as a foreign body and send antibodies to attack it. These antibodies inflame the thyroid, causing hormone overproduction.
Another reason for thyroid surgery is the swelling or enlargement of the thyroid gland. This is referred to as a goiter. Like large nodules, goiters can block the throat and interfere with eating, speaking, and breathing.
There are several different types of thyroid surgery. The most common are lobectomy, subtotal thyroidectomy, and total thyroidectomy.
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Surgical Management Of Graves Disease
WHO SHOULD CONSIDER THYROIDECTOMY FOR MANAGEMENT OF GRAVES DISEASE?
Thyroidectomy should be considered for anyone with Graves diseaseand moderate-to-severe eye disease, or smokers with GD due to increased risk of exacerbation of eye disease after radioactive iodine. Women with GD who are pregnant, nursing, or who have young children at home would benefit from a surgical consultation in an effort to avoid radiation exposure to the home. Patients who are found to have an associated thyroid cancer or a nodule suspicious for thyroid cancer should undergo thyroidectomy as the primary treatment. Anyone with GD who is interested in a rapid resolution of hormone control and hopes to avoid a prolonged transition from hyperthyroidism to hypothyroidism would benefit from surgical consultation. Any patient with compressive symptoms due to the associated thyroid enlargement from their GD would benefit from surgical consultation. Patients who are having difficulty with hormonal control while on medications, or have experienced a severe side effect from anti-thyroid medications, may be referred for surgery.
What Causes Graves Disease
Experts dont know what causes autoimmune diseases like Graves disease. Something triggers the immune system to overproduce an antibody called thyroid-stimulating immunoglobulin . The trigger may be a combination of genes and exposure to a virus. TSI attaches to healthy thyroid cells, causing the gland to overproduce thyroid hormones.
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What Questions Should I Ask My Doctor
If you have Graves disease, you may want to ask your healthcare provider:
- What is the best treatment for me?
- What are the treatment side effects?
- Should I avoid certain medications?
- Could surgery to remove the thyroid help me?
- Does Graves disease cause other health problems?
- Should I look out for signs of complications?
How Does Graves Disease Affect Pregnancy
Thyroid hormones play a key role in the development of a babys brain and nervous system. Untreated hyperthyroidism during pregnancy can be harmful to you and your unborn child. Your healthcare provider may test your hormone levels monthly to ensure they stay within a safe range. Too much thyroid hormone during pregnancy can increase the risk of:
- Low birth weight .
- Miscarriage .
- Preeclampsia .
- Premature labor .
- Infant hyperthyroidism .
- Congestive heart failure in mother.
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Tuesday Q And A: Several Treatment Options Decrease Symptoms Of Graves Disease
DEAR MAYO CLINIC: Three months ago I was diagnosed with Graves disease. I have decided to have a thyroidectomy and want to know what to expect after the procedure. Will all of my symptoms go away immediately after surgery? What are the side effects of having the thyroid removed?
ANSWER: Thyroid removal is one of several treatment options that can effectively decrease symptoms of Graves disease. Others include anti-thyroid medications and radioiodine. Each person is different, and no one treatment is best for everyone. A thyroidectomy often relieves symptoms of Graves disease. But as with all surgery, there are risks and possible complications associated with thyroidectomy.
Graves disease is an immune system disorder that results in the overproduction of thyroid hormones, a condition known as hyperthyroidism. Because thyroid hormones affect many of your bodys functions, signs and symptoms of Graves disease can be wide ranging.
Medications that interfere with the thyroids use of iodine to produce hormones, known as anti-thyroid medications, may be helpful in controlling the disease. These prescription medications include propylthiouracil and methimazole.
Treating Graves disease with a thyroidectomy involves removing all or nearly all of the thyroid gland. The main side effect of not having a thyroid is the need for ongoing thyroid medication usually one pill a day. Treatment with radioiodine also results in a need for life-long thyroid medication.
Thyroid Eye Disease Center
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The eye changes associated with thyroid disease are referred to as Thyroid Eye Disease . Your doctor may also use the term Thyroid Associated Orbitopathy . Although TED is seen in all types of thyroid disorders, it is most common in patients that are or were hyperthyroid. It also rarely occurs in those who are hypothyroid and even when there is an absence of thyroid abnormalities in the body.
Thyroid disease can cause multiple eye problems. These include redness and swelling, double vision, decreased vision, eyelid retraction , and a bulging of the eye itself. It is important to realize that if one of these occurs, it does not mean you will necessarily get all the other symptoms too.
Eye problems will usually occur and frequently change in type or severity for between six months and two years. Once stabilized, it is unusual for the eyes to start changing again. Some patients are left with permanent changes, and in others the eyes return to normal. A great deal can be done to improve these conditions with medical treatment, although some patients will need surgery to help ease their issues.
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