Hyperthyroidism secondary to toxic multinodular goiter can be treated by any of the following means:
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Surgery:
Usually done when the goiter is large and causes significant cosmetic disfigurement. Patient is made euthyroid with the help of antithyroid drug, Carbimazole or Methimazole and surgery is planned when patient becomes euthyroid.
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Antithyroid drugs
Anti-thyroid drugs are used to make the patient euthyroid (Normal TSH level). Once patient becomes euthyroid surgery can be planned. Antithyroid drugs also decrease the size of thyroid gland to some extent, but usually not significant and surgery or radioactive iodine is used eventually. If patient doesn’t want surgery or radio-active iodine is contra-indicated then patient can be maintained on antithyroid drugs for longer period of time.
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Radioactive iodine
Radioactive iodine is used when the size of toxic multi-nodular goiter is not very large. Or it is considered when a patient doesn’t want surgery and a large sized goiter is first reduced by using anti-thyroid drugs (e.g carbimazole) for few months and once patient becomes euthyroid and the size reduces then radio-active iodine is used. 370 Mbqs of radioactive iodine are given (I-131), and the size of goiter is monitored for 3 to 6 months. After 3 to 6 months the dose can be repeated.
So in general, first a hyperthyroid patient is made euthyroid by giving carbimazole or methimazole and once the patient becomes euthyroid, then either surgery is done or radioactive iodine is given to treat the goiter (decrease the size of the thyroid gland). The choice usually depends on the size of the goiter, if the patient is willing and size is large then surgery is preferred. If size is not much large or patient is unwilling for surgery then radioactive iodine is considered.
Keywords: Radioactive iodine in hyperthyroidism, dose of radioactive iodine, when to give radioactive iodine in hyperthyroidism, how to give radioactive iodine in hyperthyroidism.
