Treatment of Graves' Disease (Hyperthyroid state):

The choice of treatment depends upon the age and overall condition of the patient, the size of thyroid gland, and patient preference.

Currently, there are at least three methods of treatment: drugs that inhibit production of thyroid hormone or provide symptomatic relief, the use of radioactive iodine to destroy part of the thyroid gland and thereby reduce hormone production, or surgical removal of part of the gland.

Drug therapy. Your doctor will prescribe either methimazole (Tapazole) or propylthiouracil (PTU) pills. These drugs act to prevent the thyroid from manufacturing the thyroid hormone.

The side effects of this medication may be drowsiness and minor lethargy; in rare cases, they can cause agranulocytosis, a blood disease. Most of the time, however, this form of therapy is safe and restores normal hormone balance within a couple of months.

Another medication, propranolol, is a beta-blocker that helps relieve the symptoms of Graves' disease including rapid heart rate, tremor, sweating and anxiety. Iodinated contrast agents can also provide effective treatment for hyperthyroidism of any cause.

Radioactive iodine therapy. This is an alternative if drug treatment fails. You are given a capsule or a drink of water containing radioactive iodine. After being swallowed, the "radioiodine" is rapidly absorbed by the overactive thyroid cells and are destroyed by the radiation, so less thyroid hormone is produced.

The radioactivity disappears from the body within days. You should not undergo radioactive iodine therapy if you are pregnant as the radiation can adversely affect a developing fetus.

Surgery. Thyroidectomy is surgical removal of all or part of the thyroid gland. If only a single lump or nodule within the thyroid is producing too much hormone, the surgeon can take out just that small part of the gland. If the entire gland is overactive, which is more often the case, a total thyroidectomy is needed.

Surgery is the preferred treatment for people with a large goiter who chronically relapse after drug therapy, if there is a risk of cancer, and for people who refuse or are not candidates for radioactive iodine therapy, such as pregnant women. Depending on how much of the gland is left after surgery, you may need subsequent thyroid replacement therapy.