Treatment:

The purpose of treatment is to control the overactivity of the thyroid gland. Beta-blockers such as propranolol are often used to treat symptoms of rapid heart rate, sweating, and anxiety until the hyperthyroidism is controlled. Hyperthyroidism is treated with one or more of the following:

• Antithyroid medications
• Radioactive iodine
• Surgery

If you have radiation and surgery, you will need to take replacement thyroid hormones for the rest of your life, because these treatments destroy or remove the gland.

Some of the eye problems related to Graves disease usually improve when hyperthyroidism is treated with medications, radiation, or surgery. Radioactive iodine can sometimes make eye problems worse. Eye problems are worse in people who smoke, even after the hyperthyroidism is cured.

Sometimes prednisone (a steroid medication that suppresses the immune system) is needed to reduce eye irritation and swelling.

You may need to tape your eyes closed at night to prevent drying. Sunglasses and eyedrops may reduce eye irritation. Rarely, surgery or radiation therapy (different from radioactive iodine) may be needed to return the eyes to their normal position.

Expectations (prognosis):

Graves disease often responds well to treatment. However, thyroid surgery or radioactive iodine usually will cause hypothyroidism. Without getting the correct dose of thyroid hormone replacement, hypothyroidism can lead to:

• Depression
• Mental and physical sluggishness
• Weight gain

Antithyroid medications can also have serious side effects.

Complications:

• Complications from surgery, including:
  • Hoarseness from damage to the nerve leading to the voice box
  • Low calcium levels from damage to the parathyroid glands (located near the thyroid gland)
  • Scarring of the neck
• Eye problems (called Graves ophthalmopathy or exophthalmos)
• Heart-related complications, including:
  • Rapid heart rate
  • Congestive heart failure (especially in the elderly)
  • Atrial fibrillation
• Thyroid crisis (thyrotoxic storm), a severe worsening of overactive thyroid gland symptoms
• Increased risk for osteoporosis, if hyperthyroidism is present for a long time
• Complications related to thyroid hormone replacement
  • If too little hormone is given, fatigue, weight gain, high cholesterol, depression, physical sluggishness, and other symptoms of hypothyroidism can occur
  • If too much hormone is given, symptoms of hyperthyroidism will return

Calling your health care provider:

Call your health care provider if you have symptoms of Graves disease. Also call if your eye problems or general symptoms get worse (or do not improve) with treatment.

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of hyperthyroidism with:

• Decrease in consciousness
• Fever
• Rapid, irregular heartbeat