Thyroid Disease Treatment in South Africa

Thyroid disease occurs when the thyroid produces either too much or too little of the thyroid hormones. A properly functioning thyroid maintains the right amount of hormones required to keep the body’s metabolism functioning normally. The thyroid replaces the hormones as they are used. The thyroid hormones are monitored and controlled by the pituitary gland which is located in the center of the skull below the brain. When the pituitary gland senses a change in thyroid hormone levels, it adjusts its own hormone (TSH) and sends s it to the thyroid to signal it what to do.

• Hyperthyroidism: This is a medical condition which occurs when the patient has an overactive thyroid causing the thyroid gland to produce too much of thyroxine. When the thyroid produces too many hormones, it results in the body using energy faster than it should.
• Hypothyroidism: This is a common disorder in which the thyroid gland doesn’t produce enough thyroid hormone. It is also known as underactive thyroid or low thyroid. It results in the body using energy slower than it should.

There are several different causes of thyroid disease. The conditions that causes hypothyroidism include thyroiditis, postpartum thyroiditis, Hashimoto's thyroiditis, iodine deficiency and a non-functioning thyroid gland. The conditions which causes hyperthyroidism include thyroiditis, Graves’ disease/diffuse toxic goiter (enlarged thyroid gland), overactive nodules within the thyroid, and excessive iodine.

• Antithyroid drugs: These are drugs prescribed to slow down the production of thyroid hormones. They are also called thyrostatics. Once thyrostatics are administered, it can take a couple of days to become effective. Additionally, the dose needs to be carefully titrated over a period of months, with regular doctor visits as well as blood tests to monitor results so as to prevent hypothyroidism.
• Beta-blockers: A patient suffer from hyperthyroidism may also obtain immediate temporary relief before permanent treatment can take place. Beta-blockers only relieve the symptoms and do not treat hyperthyroidism or any of its long-term effects if left untreated.
• Diet: People with autoimmune hyperthyroidism are advised to make dietary changes and increase the intake of foods high in iodine. It is advisable to use iodized salt.
• Surgery: Surgery can be performed to remove a part or the whole thyroid a procedure called thyroidectomy. However, this is not extensively used because most common forms of hyperthyroidism are successfully treated by other methods.
• Radioiodine: Radioactive iodine treatment can be used to destroy the thyroid tissue. At first, symptoms of hyperthyroidism may worsen following the treatment, since the thyroid hormones are released into the blood via the radioactive iodine treatment. However, medications such as beta blockers may be used during this period of time and a good number of patients are able to tolerate the initial few weeks without any problems.

• Hormone replacement: This is the most common way of treating hypothyroidism and entails administering a synthetic long-acting form of thyroxine.
• Desiccated animal thyroid: This is an animal based thyroid gland extract which contains forms of T4, T2, calcitonin, T3, and T1. However, its use today is unsupported by evidence.
• Intensive care admission: Severe decompensated hypothyroidism or Myxedema coma usually require admission to the intensive care unit. In severe cases, mechanical ventilation may be used as well as vasopressor agents, careful rewarming, fluid replacement, and corticosteroids.

Thyroid cancer is usually treated by surgical removal of the cancerous tissue. The whole thyroid gland may also be removed in a procedure called thyroidectomy. If cancer has spread beyond the thyroid affected tissue is also removed.