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Harvard Medical School

Graves' Disease

Treatment

Treatment focuses on two goals: rapidly improving the hyperthyroid symptoms, and slowing the thyroid's production of thyroid hormone.

Symptoms of palpitations, increased heart rate, tremor and nervousness are treated with a beta-blocker medication such as propanolol (Inderal). For anxiety and insomnia, your doctor may prescribe diazepam (Valium), lorazepam (Ativan) or a similar medication.

To stop the thyroid from producing too much hormone, there are three possible treatments: antithyroid medications, radioactive iodine, and surgery.

For most people with Graves' disease, doctors usually start with antithyroid medication, such as methimazole (Tapazole, Thiamazole) or propylthiouracil (sold as a generic). Once thyroid hormone levels have reached normal, you and your doctor can decide whether to continue daily anti-thyroid medication or to choose radioactive iodine treatment.

Radioactive iodine is given by mouth. Most specialists recommend a large enough dose to completely stop the thyroid from producing thyroid hormone. You would then have to take thyroid medication daily for the rest of your life. Because people who receive radioactive iodine therapy temporarily store a small amount of radiation in their thyroid, they need to avoid prolonged contact with pregnant women and children for several days following treatment. Radioactive iodine is concentrated in breast milk and women must stop breast feeding if they choose this therapy.

Surgery for Graves' disease is rarely done today. However, people with very large goiters are less likely to respond well to anti-thyroid medication or radioactive iodine, and may have a better outcome if most of the thyroid gland is removed surgically (called subtotal thyroidectomy).

Patients with eye signs of Graves' disease may be given eye drops to keep the eyes moist and tinted eyeglasses to protect the eyes from sun, wind and dust. In people with severe eye symptoms, glucocorticoid medications may be necessary, either alone or together with radiation treatments to the muscles that control eye movement. Skin symptoms of Graves' disease may be treated with glucocorticoid creams and ointments.