An Overview of Thyroid Disease Treatments

The treatment for your thyroid condition depends on the type of thyroid problem and whether your thyroid is overactive, underactive, enlarged, or is cancerous. Here is an overview of the different treatments provided for thyroid conditions.

Hyperthyroidism/Graves' Disease Treatments

When your thyroid is acutely or chronically overactive—a condition known as hyperthyroidism—you are producing too much thyroid hormone. Hyperthyroidism is most often due to the autoimmune condition known as Graves’ disease, or in some cases due to thyroid nodules that produce excess thyroid hormone or thyroiditis.

All hyperthyroid patients should be initially treated with beta-blockers. Specific treatments for Graves' disease include:

• Antithyroid drugs, including methimazole (Tapazole), propylthiouracil (PTU), and carbimazole (Neo-Mercazole). Because PTU is sometimes associated with some serious side effects, methimazole is considered the preferred antithyroid drug in the U.S. (PTU, however, is recommended for treatment during the first trimester of pregnancy due to a slightly increased risk of birth defects associated with methimazole.)
• Radioactive iodine treatment (RAI), also known as radioiodine ablation. This treatment involves taking a dose of radioactive iodine, which then is absorbed by the thyroid and destroys—or ablates—all or part of the gland’s ability to manufacture thyroid hormone.
• Surgical removal of all or part of the thyroid, known as a thyroidectomy. Surgery is an option for women who are pregnant, nursing or have young children and want to avoid radiation exposure at home.

Geography is also a factor. In the U.S., RAI was commonly prescribed for Graves’ disease but recently there’s been a shift toward antithyroid drugs. If your hyperthyroidism due to Graves’ disease persists after 6 months, then your healthcare provider may recommend definitive treatment with either radioactive iodine or surgery. Outside of the U.S., antithyroid drug therapy is more likely to be a healthcare provider’s first choice for treatment, and surgery is more widely used, especially for children and women of childbearing age. Most thyroid patients who receive RAI treatment or have surgery eventually end up hypothyroid, and are treated with thyroid hormone replacement drugs.

Some controversial, cutting-edge therapies for treatment include block/replace therapy (BRT)—a combination of thyroid hormone replacement drugs and antithyroid drugs—and a procedure known as thyroid arterial embolization.

Some integrative healthcare providers recommend stress reduction and management approaches like guided meditation, antithyroid dietary and nutritional changes, traditional Chinese medicine, and other holistic approaches to help an overactive thyroid.

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Goiter Treatments

Goiter refers to an enlarged thyroid, which can develop in both hypothyroidism and hyperthyroidism.

Depending on the size and location, if you have a goiter, it may cause a feeling of fullness in your neck, pain, and less commonly, may make it difficult to swallow or breathe.

If you have a small goiter that is not symptomatic and is not accompanied by any irregularities in your thyroid levels, your healthcare provider may decide to monitor—not treat—your goiter.

For a small, symptomatic goiter, healthcare providers typically treat you with thyroid hormone replacement drugs. In some cases, the drugs can slow down or stall the growth of your goiter but are not likely to shrink it.

If your goiter is large, continues to grow despite being on thyroid hormone, bothers you cosmetically, or is interfering with swallowing or breathing, your healthcare provider may recommend radioactive iodine (RAI) to shrink your thyroid, or surgery to remove all or part of your thyroid gland.

In the case of a goiter that is due to iodine deficiency, your healthcare provider will likely recommend use of supplemental iodine.

Thyroid Nodule Treatments

The majority of thyroid nodules are benign. Many healthcare providers prefer to monitor patients for small, benign nodules that cause no symptoms. A substantial percentage of the population—some experts suggest the majority of people—have these asymptomatic nodules, and require no further treatment.

In some cases, if the nodule is accompanied by hyperthyroidism, radioactive iodine (RAI) is used, to shrink the nodule and the thyroid gland. If the benign nodule is larger and unresponsive to medication or RAI, surgery is often recommended.

Another approach being used for nodules is percutaneous ethanol injection (PEI), where the nodule is shrunken by an injection. Another promising new non-surgical technology for nodules is high-intensity ultrasound beam technology.

If a nodule or multiple nodules are determined to be cancerous, your thyroid is almost always surgically removed all or in part. In the case of malignancy, thyroid cancer treatment protocols are followed based on the type of cancer detected.

In the past, thyroidectomy was performed after a fine needle aspiration (FNA) showed indeterminate or inconclusive nodules, but the relatively new Veracyte Afirma Thyroid Analysis process greatly reduces these indeterminate results and prevents unnecessary surgery.

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.

Thyroiditis Treatment

Thyroiditis refers to an inflammation of your thyroid gland. While autoimmune (Hashimoto’s) thyroiditis is the most 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, healthcare providers typically recommend a pain-reliever with anti-inflammatory properties, such as aspirin, ibuprofen (Advil/Motrin), or naproxen (Aleve).

If the thyroiditis is especially acute, healthcare providers 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.

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

Thyroid Cancer Treatment

There are four different types of thyroid cancer: papillary, follicular, medullary, and anaplastic. The treatments for thyroid cancer 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 treatment to kill cancer cells. For thyroid cancer, radiation is most commonly given in a liquid or pill containing radioactive iodine (RAI). The thyroid absorbs iodine, and the radioactive form of iodine collects in thyroid tissue and kills cancer cells. In some cases, the radiation is delivered from outside the body, targeted specifically at the thyroid, and is known as external beam radiation.
• Hormone therapy, using thyroid hormone replacement drugs. After thyroid surgery or RAI, you are likely to become hypothyroid, and require lifelong prescription thyroid hormone replacement drugs. In some cases, healthcare providers will recommend a dose that will keep your TSH low or undetectable, to help prevent thyroid cancer from recurring.
• Targeted therapies, including a variety of new drugs for different types of thyroid cancer, including those that are resistant to radioactive iodine treatment.
• Chemotherapy is not common, but it may be used in some cases, primarily to help relieve symptoms.

Hypothyroidism/Hashimoto's Disease Treatment

Hypothyroidism is a condition where the thyroid is underactive, chemically destroyed, or surgically removed, and therefore unable to produce sufficient levels of thyroid hormone. We’ve left it for last because, to a large extent, most other thyroid treatments–because they involve radioactively ablating or surgically removing the thyroid–often end up with you becoming hypothyroid.

Thyroid hormone replacement drugs replace the missing thyroid hormone in your body. They include the following:

• The most commonly prescribed thyroid hormone replacement drug is known generically as levothyroxine, a synthetic form of the thyroid hormone thyroxine (T4). Commonly known brand names include Synthroid, Levoxyl, Unithroid, and Tirosint.
• There is also a synthetic form of the T3 hormone, known as liothyronine, that is sometimes added to levothyroxine for T4/T3 combination treatment. The brand name in the U.S. is Cytomel.
• Also, there is a hormone replacement drug called natural desiccated thyroid, sometimes abbreviated NDT or called "thyroid extract." While it has been available for more than a century and is still in use today, NDT is considered controversial by the mainstream medical community, but it is prescribed more often by holistic and functional medicine physicians. Common brand names include Nature-throid, Armour Thyroid, and WP Thyroid.

Treatment of Hashimoto’s disease, the autoimmune condition that often results in hypothyroidism, is more controversial. Most mainstream healthcare providers believe that Hashimoto’s requires no treatment, and they only treat with thyroid hormone replacement drugs when Hashimoto’s has resulted in hypothyroidism.

Some healthcare providers believe that Hashimoto’s disease, which can be confirmed by testing for thyroid antibodies, warrants treatment in some patients who are symptomatic, even if other thyroid levels are normal. There is also some evidence that treating Hashimoto’s disease with thyroid hormone replacement drugs before the thyroid stimulating hormone (TSH) level rises may alleviate some symptoms. A woman with Hashimoto's and TSH >2.5 that would like to become pregnant should be started on thyroid hormone replacement with the goal of having her TSH <2.5

Some research also suggests that treating someone with Hashimoto’s who otherwise has normal blood tests, including a normal TSH level, may help prevent elevation of the TSH level and progression to full hypothyroidism. Treating Hashimoto's when the TSH is normal is controversial, however.

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

Other integrative treatment approaches include:

• Supplementation with selenium to lower antibodies
• Addressing related adrenal imbalances that may be complicating thyroid treatment
• Dietary changes to reduce inflammation
• Eliminating gluten from the diet due to a connection between gluten and autoimmunity
• Stress reduction and management