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Hyperthyroidism : Treatment
Western Medicine
Chinese Medicine
Three forms of treatment are available for hyperthyroidism:

drug therapy
the use of radioactive iodine, and

The choice of treatment will depend on the cause of thyrotoxicosis and on its severity.

Drug therapy
Drug therapy includes the use of beta-blocking agents and antihthyroid drugs.

Beta blockers
Many of the symptoms of thyrotoxicosis, such as tremor, anxiety and palpitations, can be relieved very quickly by giving drugs known as beta blockers. These drugs (eg, propanolol) reduce stimulation of certain parts of the nervous system and decrease the activity of the heart. They do not have an effect on thyroid production, but in temporary forms of hyperthyroidism, such as thyroiditis, the use of beta blockers alone may be sufficient to control symptoms. Beta blockers are also very useful for preoperative preparation of patients for thyroid surgery.

Antithyroid drugs
Most patients with hyperthyroidism are given antithyroid drugs as initial therapy. The drugs commonly used are methimazole, carbimazole and propylthiouracil. They interfere with the ability of the thyroid gland to synthesize its hormones and are usually given in high doses until the thyroid gland functions normally (becomes euthyroid). This can take one to two months.

Patients with mild to moderate disease can usually then have the dose of antithyroid drug gradually reduced to the smallest that will maintain the euthyroid state. The maintenance dose will need to be continued for at least a year and possibly two. In some cases, therapy may need to be lifelong.

Sometimes the initial higher dose is maintained and supplemental thyroxine given. Some authorities consider that this regime provides a greater chance of lasting remission when the antithyroid drug is finally withdrawn, but the issue is controversial. Either way, therapy needs to be continued for at least one year to 18 months.

If therapy is withdrawn, frequent follow-up is important to make sure that remission is maintained. Relapses following withdrawal of therapy are common and occur in 50 per cent of patients, usually within two years.

Methimazole (available in the US) needs usually to be taken once daily only. Improvement in symptoms is seen in one to three weeks and control of symptoms is achieved in one to two months. Carbimazole (available in the UK) is rapidly and completely metabolized to methimazole in the body and it is this that is responsible for the clinical antithyroid activity. The dosage and use of both drugs is similar.

Both drugs can cause a skin rash. This occurs in about two per cent of cases. A disorder of white blood cells occurs much more rarely, but if a severe sore throat or mouth ulcers develop, patients should consult their doctors immediately.

Although methimazole and carbimazole are the drugs of choice in the treatment of hyperthyroidism, propylthiouracil is often prescribed instead if a patient develops a rash or is contemplating pregnancy. (Methimazole and carbimazole, taken before and during pregnancy, have been associated with abnormal nail growth in the fetus.)

Patients with severe hyperthyroidism or recurrent, relapsing disease may require to be treated with radioactive iodine or surgery.

Radioactive iodine
Radioactive iodine is iodine that has been bombarded with neutrons to create a different form of the element (an isotope). Radioactive isotopes are unstable and decay releasing a form of radiation. It is this principle that is used in radioactive iodine treatment.

The thyroid cells are the only cells in the body that are able to absorb iodine. By giving radioactive iodine, cells in the thyroid are damaged or destroyed and are unable to produce further thyroid hormone. There is little risk of radiation exposure to the rest of the body. A single dose of radioactive iodine, taken by mouth, is usually sufficient to provide permanent treatment. An endocrinologist will carefully calculate the dose before administration based on the results of the thyroid function tests. The drug is eliminated from the body within a few days, although it may be several weeks before the effect of the treatment is seen. During this time it is necessary to continue taking antithyroid drugs.

It is difficult to predict exactly the dose of radioactive iodine a patient needs to achieve the euthyroid state and sometimes after treatment the thyroid gland produces too little hormone (becomes hypothyroid). In this case, supplemental thyroid hormone in the form of thyroxine needs to be taken. Lifelong follow-up of thyroid function is needed for patients who receive radioactive iodine.

Radioactive iodine is commonly given in the following circumstances:

In patients with Graves' disease unable to achieve lasting remission from disease with antithyroid drugs.
As the treatment of choice for patients with toxic nodular goiter. (The incidence of hypothyroidism is much less common than after treatment for Graves' disease.)
In the treatment of toxic adenoma. This also rarely results in hypothyroidism, as the shriveled cells around the nodule in the gland take up little or no radioactive iodine.
Increasingly it is being considered as first-line therapy for adults with hyperthyroidism.

Radioactive iodine must not be given to children, or to women during pregnancy or breast-feeding.


Surgery is mainly used for the treatment of hyperthyroidism that results from over-production of hormones in a section of the gland (rather than a diffuse over-activity) and it is reserved for a minority of patients with thyrotoxicosis.

However, some medical centers prefer its use to radioactive iodine in the treatment of recurrent Graves' disease. It is otherwise generally indicated in Graves' disease for those patients who:

have very large goiters
cannot tolerate antithyroid medicine
refuse radioactive iodine treatment
have opthalmopathy (staring/bulging eyes), or
are young women and contemplating pregnancy.

The operation usually requires only a short stay in hospital. There is a small risk of injury during the procedure to structures lying adjacent to the gland, in particular to the nerve supply to the voice box. As with radioactive iodine treatment, the method can result in hypothyroidism if too much gland is removed, although the risk is less. Thyroid surgery should be undertaken only by an experienced specialist surgeon.

In nodular toxic goiter and toxic adenoma, surgery is commonly employed as an alternative to radioactive iodine treatment. The affected area of the gland or an entire lobe may be removed.

Finally, any nodular enlargement of the thyroid needs to be investigated, preferably by fine-needle aspiration biopsy and ultrasonography, to exclude the possibility of a malignant (cancerous) growth.


The treatment of hyperthyroidism can be based either on syndrome differentiation or on symptoms.

Therapies based on TCM syndrome differentiation

Liver-qi stagnation, spleen deficiency and phlegm accumulation

Therapeutic aim: To relieve stagnation, reinforce the spleen, eliminate dampness and phlegm evils, soften and shrink the goiter.

Decoction of Six Mild Drugs plus Xiaoyao Powder (modified)
chai hu hare's ear (root)
dang gui Chinese angelica
bai shu large head atractylodes root
fu ling Indian bread
gan cao liquorice root
zhi ban xia pinellia tuber (processed)
chen pi dried tangerine peel
xiang fu nut-grass
bai shao white peony root
bai ji li caltrop
xia ku cao self-heal
bai jie chi white mustard
ze qi sun spurge

Deficiency in both qi and yin

Therapeutic aim: To benefit the qi and replenish the yin.

Prescription: Decoction of Six Drugs containing Rehmannia Rhizome plus Powder for Restoring Pulse Beat (modified)
dang shen pilose asiabell root
mai dong lily-turf
wu wai zi schisandra
sheng di fresh rehmannia rhizome
shan yao Chinese yam
shang yu rou Asiatic cornelian cherry
bai shao white peony root
huang qi milk-vetch root
gou qi chi Chinese wolfberry fruit
sheng mu li fresh oyster shell
zhi shou wu fleece flower root (processed)
sheng gan cao fresh liquorice root

Yin-deficiency and yang-hyperactivity

Therapeutic aim: To benefit the qi and replenish the yin, nourish the kidneys and depress the yang.

Basic prescription
huang qi milk-vetch root
dang shen pilose asiabell root
sheng di fresh rehmannia root
gou qi chi Chinese wolfberry fruit
zhi shou wu fleece flower root (processed)
shan yao Chinese yam
gui ban tortoise shell
bai shao white peony root
bie jia turtle shell
xia ku cao self-heal
xiang fu

For individuals with severe goiter add:
bai jie chi white mustard

For individuals with palpitation and insomnia add:
yuan zhi Chinese senega
ci shi magnetite

For individuals with severe hand tremor add:
zhen zhu mu nacre
gou teng gambir vine

For individuals with severe stomach-heat and excessive appetite add:
tian hua fen trichosanthes (root)
mai dong lily-turf
yang shen figwort root

Therapies based on symptoms

Chinese medicine is also commonly used for symptom relief. In the treatment of hyperthyroid-related symptoms the following herbal medicines may be employed:

Profuse sweating:

mu li san oyster shell powder
Or where sweating is extreme:
huang qi milk-vetch root
fu xiao mai wheat (shriveled)

Palpitation, nightmares and insomnia:

suan zao ren spine date seed
yuan zhi Chinese senega
long gu fossil bone
ye yiao teng Chinese cornbind
zhen zhu mu nacre

Protruding eyes:
This is a difficult problem to treat. Relief can be obtained by removing heat from the liver and improving vision.
The main ingredients in the decoction include:
zao xiu paris
bai lian ampelopsis
lou lu fresh abalone shell
zhen zhu mu nacre
shi hu dendrobium
ju hua chrysanthemum
gou qi chi Chinese wolfberry
mi meng hua buddleia
qian li guang ragwort
gu jing cao pipewort