Deciding on the best treatment for Graves’ disease may seem difficult and complicated. But remember that all three forms of treatment are likely to be effective and provide a good outcome if used properly by an experienced physician.
Also, patients don’t have to make a decision right away about taking a radioactive iodine treatment or having surgery. Many patients decide to start on PTU or methimazole along with a beta-blocker, and then rethink their options after they are feeling better and calmer.
I think this is a good short-term approach to treating the disease, and I often recommend it to my patients. Remember also that the choice of therapy belongs to the patient. The physician may make recommendations to the patient based on her or his experience, and the patient should consider these suggestions carefully. But it is important that the patient feel comfortable with the treatment that he or she chooses.
In considering the long-term treatment options of antithyroid prescription drugs, radioactive iodine or surgery, patients might ask themselves the following questions:
How well do I take medications?
If you decide to take antithyroid drugs for the long term, you will need to take several pills a day for many months. Some individuals just do not like to take medications, and they know that they will have trouble keeping on schedule with their pills.
If you fall into this category, you might want to consider a radioactive iodine treatment early on. As discussed above, you are still likely to end up on a thyroid supplement once a day after this treatment, but that will be easier that sticking with antithyroid drugs.
How quickly do I want to get this Graves’ disease out of my life?
If you are very anxious to get your Graves’ disease over and done with, then surgery offers you the best treatment option. After surgery you will be placed on a thyroid hormone supplement that may require adjusting, but then you are done. From start to finish, this should take about two months. A radioactive iodine treatment will accomplish the same thing in about six months.
With antithyroid drugs, you are in for the long haul, with no assurances as to when you will be able to stop the medications. Most physicians recommend sticking with the medications for at least six to 12 months. Of course, if the medications are adjusted properly, you should be feeling quite well during your treatment. But you will still require checkups about every three to six months after the initial adjustment period.
Do I really want to have surgery?
In my experience, most people want to avoid surgery if possible. In treating Graves’ disease, surgery is rarely absolutely necessary. Furthermore, the risks of surgical complications involving the vocal cords or the parathyroid glands (though unlikely) often give patients second thoughts about this form of therapy. Since two other good forms of treatment are available, most patients elect not to have surgery.
How comfortable do I feel swallowing a pill that is radioactive?
As a physician and a medical scientist, I think a radioactive iodine treatment is a safe and very effective form of therapy for Graves’ disease. Many of my patients choose this form of therapy.
However, some patients feel uncomfortable with this treatment, despite reassurances that it is safe. Also some patients don’t like the idea that radioactive iodine (and surgery) causes permanent damage to their thyroid gland. They would rather work with medications for several months to see if their Graves’ disease will reverse itself.