You may not spend as much time thinking about your thyroid, but it does a lot for you. The small butterfly-shaped gland in your neck helps regulate body temperature, heart rate and metabolism.
If you have Graves’ disease, an autoimmune disorder that affects five times as many women as men, the body’s immune system mistakenly attacks itself. Certain autoimmune diseases, such as Graves’ disease, are caused by harmful immunoglobulin G autoantibodies (IgG). In Graves’ disease, these harmful autoantibodies attack the thyroid and cause it to produce more hormones than the body needs, which can lead to anxiety, heart palpitations, tremors, severe fatigue, weight loss, and other health problems that can be serious.
Treatment for Graves’ disease has changed little in the last 70 years. But that is finally changing, as several clinical trials are currently underway testing possible treatment options.
Here’s a closer look at some of the current and standard treatments, as well as some of the new treatments and clinical trials currently underway.
Treatment options for Graves’ disease
Thyroid medications
Treatment for Graves’ disease can vary depending on symptoms, individual response and other factors, but Jennifer Cheng, DO, chief of endocrinology at Jersey Shore University Medical Center, said her first step is typically medication.
Antithyroid medications can be used to prevent the thyroid from producing too much hormone, but they do not treat the underlying cause of the condition. Methimazole (MMI) and propylthiouracil (PTU) are two of the most commonly administered thyroid medications with Graves.
Cheng pointed out that because Graves’ disease often comes and goes, and people with Graves’ disease alternate between periods of improvement and relapses (called flare-ups), it is helpful to take medication first. In some cases, the thyroid may become hyperactive, then stabilize, and then possibly return to a hyperactive state. Medications are ideal for these patients because they can be stopped or started as needed.
However, thyroid medications do not treat the underlying cause of the condition. They also don’t work for everyone. Some people also struggle with symptoms while taking medication. And others can’t take them because they have certain medical conditions, are pregnant, or can’t tolerate the side effects. When people stop taking their medications, they often relapse and experience symptoms again.
Beta blockers
Beta blockers may be prescribed in conjunction with thyroid medications to relieve some of the symptoms of hyperthyroidism before the thyroid medications take effect. They do not treat Graves’ disease, but they can help relieve symptoms.
Therapy with radioactive iodine (RAI).
In cases where medications no longer effectively treat the disease or medications are not an option for a patient, therapy with radioactive iodine (RAI) – also known as RAI ablation – can be used.
In RAI, the patient swallows a radioactive pill that, over time, partially or completely destroys the part of the thyroid that produces the hormone. This process can take weeks to months. Since this part of the thyroid is destroyed, there is no risk of excessive hormone production.
There are two limitations to RAI therapy: first, it cannot be used in people who have developed thyroid eye disease due to their Graves’ disease, as it can worsen the condition, and second, it causes hypothyroidism when thyroid hormone levels become too low. In this case, the person must take thyroid hormone replacement medication for life.
operation
In some cases, surgery to remove part or all of the thyroid may be the best route for someone who may have a severely enlarged thyroid or who is at risk of developing thyroid cancer. However, similar to RAI, removal of the thyroid results in complete loss of all thyroid function and requires lifelong thyroid hormone replacement therapy.
New treatments
Cheng also provided an overview of some of the newer medications being studied for the treatment and symptom management of Graves’ disease.
- IMVT-1402: This treatment is currently being studied in clinical trials to normalize thyroid function in people with uncontrolled Graves’ disease. This is a monoclonal antibody, a treatment that reduces disease-causing autoantibodies. This option could be helpful for people who cannot control their symptoms with thyroid medications.
- Rituximab: This medication targets certain types of white blood cells and may help reduce relapse rates when used with antithyroid medications (called adjuvant therapy). Although combination therapy is not yet used regularly for Graves’ disease, some exploratory studies have been conducted.
Other approaches that influence the immune response are also being investigated and have the potential to provide additional treatment options for Graves’ disease.
Natural treatments
Healthy lifestyle changes, such as exercise, strength training, and a balanced diet rich in fresh, whole foods, can aid in the treatment of Graves’ disease but should not replace surgical or drug treatment. According to Cheng, an anti-inflammatory diet can be particularly helpful for anyone who experiences inflammation as part of their condition.
“It won’t heal [Graves’ disease]” said Cheng. “You still need the medication and the actual medical therapy, but [an anti-inflammatory diet] would be another way to get rid of the things that cause inflammation.”
Endocrinologist Paul Sack, MD, chief of the Division of Endocrinology and Metabolism at MedStar Union Memorial Hospital, cautioned that any type of “natural” treatment, such as over-the-counter supplements or even dietary changes, should never be viewed as a panacea for Graves’ disease.
“When someone says they have a natural cure for this problem, think really hard,” Sack noted. “It’s probably too good to be true.”
This educational resource was created with support from Immunovant, a member of the HealthyWomen Corporate Advisory Council.
