Thyroid Treatments

Thyroid Treatments

by Rashmi Gulati, MD
Rashmi Gulati Head Shot

Conventional Thyroid Treatments

Hyperthyroidism is initially treated through the prescription of medications that control the production or activity of excessive thyroid hormones. Thyrostatics are a class of drugs that interfere with production of the hormones by blocking critical steps in the synthesis of the precursor hormone T4. Propylthiouracil (PROP) is a thyrostatic drug that additionally prevents the conversion of T4 to its more active form, T3. Recently the US Food and Drug Administration (FDA) has required a black-box warning to be added to the drug's label, regarding reports of severe liver injury and acute liver failure.

Because the body naturally retains T4 on reserve, there is a time delay between initiation of thyrostatic therapy and therapeutic effect. It may take a while for these drugs to have an impact on overall thyroid hormone levels, and an initially high "loading" dose may be prescribed. Beta blockers, drugs used to control heart rate and blood pressure, may additionally be prescribed to help reduce tremors, heart palpitations, and anxiety as the thyroid hormones are being rebalanced.

For more advanced cases of hyperthyroidism, radioiodine therapy may be given to destroy cells that are overproducing thyroid hormone. Iodine is readily taken up by the overactive thyroid cells. This localized destruction of the problematic thyroid cells is an approach used for over 50 years, and reported to have a high success rate in treating overactive thyroid. If a patient is allergic to iodine or is unable to undergo this therapy for other reasons, portions of the thyroid (or the gland in its entirety) may be surgically removed. Thyroid cell destruction can result in hypothyroidism, however, as does thyroidectomy, clearly; however, hypothyroidism is considered the easier condition to treat by conventional methods.

Hypothyroidism is typically treated through replacement of thyroid hormones using a synthetic form or natural forms, typically derived from pigs. Therapies may involve administration of solely T4 or a combination of T4 and T3, usually in tablets that are taken daily. Desiccated thyroid extracts from animals contain a combination of T4 and T3, and offer a potential source of natural hormone replacement. As treatment begins, the patient's thyroid hormone levels must be carefully monitored to ensure that the dosages are correct and a stable balance is achieved.

If a thyroid goiter has formed, doctors will normally perform blood tests to determine the nature of the underlying cause of the abnormal growth, and treat that directly. If the goiter is small, treatment may not be necessary. If the thyroid has increased in size such that it visibly protrudes, it may interfere with breathing or swallowing. If a goiter does not respond to hormone treatment, surgical removal of the enlarged portion, or in advanced cases the entire thyroid, may be recommended.

Thyroid Cancer Treatments

Thyroid cancer treatment protocols vary, depending upon the type of cancer involved and the extent to which it has spread. With less invasive thyroid cancer forms, such as papillary and follicular cancer, all or part of the thyroid may be surgically excised, taking into consideration the progression of the cancer and the risk that it could reoccur. If some of the thyroid remains following surgery, radioiodine treatment may also be recommended to destroy cancerous cells that are overzealously producing thyroid hormones.

Patients with medullary thyroid cancer may be candidates for surgery if the disease is caught early enough. Because this cancer spreads more aggressively, the odds of recurrence are high. The cells affected by this cancer do not take up iodine, so radioiodine therapy is not helpful. Radiation therapies, however, offer improved recovery rates. Clinical studies also show promise for treatments with tyrosine kinase inhibitors, a class of drugs that block enzymatic reactions to decrease tumor size.

Because of the extreme aggressiveness of anaplastic thyroid cancer, surgery oftentimes falls short in controlling its spread. Treatment protocols combining radiation therapy and chemotherapy are frequently used in attempt to destroy the rapidly dividing cancer cells and slow the progression of the disease, although expectations of recovery remain unfortunately low. Several new drugs have been developed to limit maturation of tumors, allowing for prolonged survival, but anaplastic thyroid cancers are generally considered to be terminal.

Holistic Thyroid Treatment

Thyroid imbalances often go undiagnosed in the absence of clear, characteristic symptoms such as thyroid enlargement or thyroid nodules. This is partly because of the generalized nature of the symptoms, and many people—patients and/or their healthcare providers—tend to downplay or brush them off. In many cases people assume the symptoms they are experiencing are simply the result of being overstressed, fatigued, or are weight issues arising in the normal course of their lives. When patients do seek help, the intangible nature of their symptoms, significant overlap between symptoms of thyroid dysfunction and a multitude of other health concerns, and highly nuanced variation in the origin of thyroid dysfunction can make proper diagnosis elusive.

Conventional blood tests for TSH, T4, and T3 levels simply cannot provide enough information to diagnose the multiplicity of thyroid disorders. Because of this, at Patients Medical, we take a comprehensive approach. Following a complete history and physical, we additionally conduct a range of screening and diagnostic tests, such as thyrotropin-releasing hormone (TRH) stimulation.

Hormone Replacement Treatment

Thyroid hormone replacement, like all hormone replacement therapies (HRT) at Patients Medical, involves individualized hormones titrated to match each individual's unique hormonal profile. We favor Thyroid USP, a natural combination thyroid product derived from animal sources. Unlike the synthetic hormones provided by conventional HRT, Thyroid USP contains a mixture of thyroid hormones in a ratio approximating 80% T4 (thyroxine) and 20% T3 (triiodothyronine). Many people report feeling much better on natural thyroid replacement than they do on conventional synthetic forms. (See our article on bioidentical hormones for more details on natural hormone replacement options.)

During medical testing, we not only measure your body's thyroid hormone levels, but evaluate function all along the hypothalamic–pituitary–thyroid (HPT), hypothalamic–pituitary–adrenal (HPA), and hypothalamic–pituitary–gonadal (HPG) axes, to gain a more complete sense of how thyroid dysfunction relates to your overall hormonal health picture. Given the intricate connections between the thyroid hormones and other hormones, a complete hormonal diagnostic work-up may be recommended. It is well-known that stress hormones, like cortisol, interact to a significant degree with thyroid hormones, for example. Rebalancing stress hormones is critical before other hormonal imbalances, such as sex hormones like estrogen, can be balanced. And it's not uncommon with stress hormones in balance, for thyroid hormones to balance themselves naturally.

Other physiological imbalances that may be contributors to or consequences of thyroid disorders will also be investigated. Some of these include blood sugar, cholesterol, and blood pressure. Tests of heart, liver, and kidney function may indicate the risks of additional complications, as well.

Depending on your current health and medical history, a number of complementary dietary, supplemental, and lifestyle changes may be recommended to improve overall health and increase the likelihood of a full recovery from thyroid imbalance. Diverse diet, balanced body composition, and regular exercise are among the most natural solutions to many health problems.

Citations and Further Reading:

US FDA. 2010. Propylthiouracil.

Cabanillas, M., et al. 2010. Treatment with tyrosine kinase inhibitors for patients with differentiated thyroid cancer: The MD Anderson experience. J. Clin. Endocrinol. Metab. [Epub ahead of print.] URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/20392874 (accessed 04.25.2010).

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