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To treat hyperthyroidism, along with the beta blockers, the doctor will probably prescribe antithyroid medications, which decrease the thyroid gland’s production of thyroid hormones. In most cases, these drugs will control the disorder within about 8 weeks, but you will need to continue taking them—sometimes for a year or longer—until your doctor tells you to stop. Although the blood level of thyroid hormones may quickly return to normal, it may take several weeks for all of the symptoms to improve. The doctor also may prescribe corticosteroid medications to lower the blood level of thyroid hormones and reduce inflammation. Although some people are eventually cured with drug treatment, in most people, symptoms recur and additional treatment is required.

Following treatment with antithyroid drugs, the doctor may perform surgery to remove either a lump in the thyroid gland or, if it is overactive, most of the thyroid gland. In most cases, surgery cures the disorder. However, in rare cases, the disease recurs or the thyroid or parathyroid glands become underactive (hypothyroidism; see next page) as a result of the surgery. In such cases, doctors usually prescribe corticosteroids.

For some people, doctors may recommend treatment with radioactive iodine. In this procedure, the person swallows a small dose of radioactive iodine in the form of a clear, slightly salty liquid. Because iodine is an essential component of some thyroid hormones, the radioactive material concentrates in the thyroid gland, where it acts on the glandular tissue to slowly control the overactivity without exposing the rest of the body to radiation. In some cases, the thyroid gland may become underactive, and you may have to take medication to treat this condition.

Each treatment has advantages and disadvantages, and your doctor will work with you to determine the best course for you. With successful treatment, most people who have hyperthyroidism are able to lead a healthy, active life.

Hypothyroidism

Hypothyroidism is a common disorder in which the thyroid gland is underactive and does not produce enough thyroid hormones. As a result, all the chemical processes in the body slow down. The severe form of hypothyroidism is called myxedema. Hypothyroidism affects women more frequently than men.

The thyroid gland may become underactive for one of several reasons. Occasionally, treatment for hyperthyroidism (see page 901), which attempts to reduce production of thyroid hormones, causes an overactive thyroid gland to become underactive. A deficiency of thyrotropin, which regulates the activity of the thyroid gland, is another possible cause of hypothyroidism.

Because the hypothalamus controls the production of thyrotropin by the pituitary gland, a disorder in either gland can lead to a deficiency of this hormone. Without an adequate supply of thyrotropin, the thyroid gland cannot function properly. Hypothyroidism may also result from Hashimoto’s disease (see page 928), an autoimmune disorder in which the immune system mistakenly attacks the thyroid gland, reducing or blocking the production of thyroid hormone. In some cases, the thyroid gland becomes underactive for no apparent reason.

Rarely, a child is born with a defective thyroid gland or without a thyroid gland, and has hypothyroidism (see page 404). If not detected and treated promptly, the condition can lead to short stature and irreversible mental retardation.

Symptoms

The symptoms of hypothyroidism develop slowly, over the course of many months or years. People who have hypothyroidism usually experience a combination of some of the following symptoms:

• Fatigue

• Slow heart rate

• Hoarseness

• Slowed speech

• Puffy face

• Constipation

• Confusion

• Depression

• Dementia

• Increased sensitivity to cold

• Decreased appetite combined with weight gain

• Drooping eyelids

• Dry hair

• Dry, scaly, thick skin

• Heavy, prolonged menstrual periods

• Loss of sexual desire

• Hearing loss

• Numbness and tingling in the