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Thyroid Diseases Articles
Treatment with radioactive iodine is one way to treat an
overactive thyroid gland (hyperthyroidism), but other medications
can work, too.
Researchers are exploring a potential link between thyroid deficiency and mental health problems. Though the findings are inconsistent, there is evidence that thyroid medication can help those with depression, even if their thyroid function is normal.
For decades, Levothyroxine sodium, the most popular thyroid hormone for replacement therapy, had not been required to go through the Food and Drug Administration's approval process. But in 1997, the FDA reclassified all oral levothyroxine products as "new drugs," obligating the manufacturers to meet approved New Drug Applications (NDAs) before August 14, 2001. A history of potency and stability problems with orally administered levothyroxine sodium products resulted in the agency's decision.Two levothyroxine sodium products, Unithroid and Levoxyl, have recently been approved by the FDA to treat hypothyroidism. And now the FDA is issuing guidance regarding the transition of patients from unapproved to these approved products, and the handling of those products being marketed without an approved application. The FDA will gradually do away with the unapproved products to allow manufacturers of approved products to expand to meet demand and to give patients and health care providers enough time for a clean transition.Two of the most common formulations that are being phased out are Synthroid and Levothroid. Manufacturers of unapproved oral levothyroxine sodium drug products without an NDA pending with the FDA must cease distribution by August 14, 2001.August 2001 Update
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Graves' disease is the most common cause of hyperthyroidism, an overactivity of the thyroid gland that results in too much thyroid hormone circulating through the body. The high thyroid level raises the body's metabolism, causing frequent bowel movements, increased heart rate, irritability, and anxiety, as well as an increased appetite partnered with weight loss. In addition, about one in five people with Graves' disease has bulging eyes. The condition is most common in young to middle-aged women.Doctors usually treat Graves' disease with antithyroid medicines, radioactive iodine treatment, or surgery. The goal of treatment is to induce long-term remission, that is, to permanently reduce the amount of hormone the thyroid gland produces. Most often, patients find antithyroid medicines effective while they are on them, but hyperthyroidism often returns once the drugs are stopped. Radioactive iodine and surgery, on the other hand, destroy or remove so much of the thyroid gland that it no longer produces enough thyroid hormone. As a result, patients need to take thyroid pills for the rest of their lives. Until now, it has been difficult for physicians to predict which treatment will be more effective for which patients.A new study, published in the March 2000 The Journal of Clinical Endocrinology & Metabolism, shows that patients under 40 and men do not respond as well to antithyroid medicines, and that men are less likely to be successfully treated with only one dose of radioiodine therapy. The researchers followed 423 patients for six months after they completed therapy. Of the patients, 314 received antithyroid medicines (usually an 18-month course of carbimazole) and 109 received radioiodine therapy.Of the patients taking antithyroid medicines, only 37% remained in remission six months after treatment. Of those, men were significantly less likely than women (20% vs. 40%) to remain in remission, and patients younger than 40 were significantly less likely than patients over 40 (33% vs. 48%) to stay in remission. Men were also significantly less likely than women (47% vs. 74%) to enter remission after one dose of radioiodine therapy.In response to these findings, the researchers proposed that men and patients younger than 40 receive early treatment with radioiodine therapy or surgery, since antithyroid medicines are unlikely to lead to remission. In addition, they suggest further research to investigate whether higher initial doses of radioiodine may be appropriate for male patients.To learn more about Graves' disease, see page 844 of the Family Health Guide.