Q: I am a 28 years old woman, been suffering from hyperthyroidism since more than 2 years. I took treatment for 2 years, after which the doctor has asked me to stop since the TSH levels had come to normal. But recently, I suffered with thyroid symptoms and have the same problem again. The doctor prescribed to continue the same tablets (Neomercazole). Is there any permanent solution for this thyroid problem? I am facing a lot of problems due to this, there is slight shivering of my hands and legs and I feel lazy too with loss of memory. Please suggest if there is any permanent treatment. Also, can I plan a second child?

A:I am enclosing some up-to-date general information about hyperthyroidism below. It is very common to have a relapse after treatment. The most suitable permanent solution is radioiodine treatment. This is a generally safe treatment, but once you had the treatment you should not become pregnant for at least 6 months and your first child should not be allowed prolonged contact for at least 7 days to avoid any radiation exposure. In hyperthyroidism, the thyroid glands produce too much thyroid hormone, which results in increased metabolism, which can cause a variety of symptoms. The pituitary gland, which is a part of the brain, controls thyroid functioning. The pituitary produces thyroid-stimulating hormone (TSH), which stimulates the thyroid to produce T3 and T4. The most common cause of hyperthyroidism is Grave’s disease and other like thyroid nodules (small growths or lumps in the thyroid gland) can sometimes produce too much thyroid hormone (the nodule is then called a hot nodule, toxic nodule, or toxic nodular goitre or thyroiditis). Hyperthyroidism can be treated. Several factors, such as age and the severity and type of hyperthyroidism, are important in determining, which treatment is best: 1. Medicine 2. Radiation 3. Surgery Anti-thyroid drugs (e.g. carbimazole or Neomercazole) are usually used for short-term in Grave’s disease and toxic nodular goitre (prior to treatment with radioiodine or surgery), or long-term in patients with Grave’s disease. After that time, there is a 20 to 30 percent chance of having a remission (re-appearance of symptoms). Some patients can relapse years later, and most people will need to eventually consider radioactive iodine or surgical treatment. Radioactive iodine - destroying the thyroid with radiation, called radioiodine ablation, is a permanent way to resolve hyperthyroidism. The amount of radiation used is small and does not cause cancer. This is the most widely used treatment in the United States. Radioiodine is given in liquid or capsule form, and it works by attacking and destroying much of the thyroid tissue. This takes about 6 to 18 weeks. People with severe symptoms, the elderly, or people with heart problems should first be treated with an anti-thyroid drug to control symptoms. Most patients who receive radioiodine become hypothyroid and need to take thyroid hormone supplements for the rest of their lives. As with most treatments, there are some risks. Sometimes, after apparently successful treatment, the condition returns and further treatment is needed. Approximately 20 percent of those who use radioiodine treatment require a second dose. These people usually have severe hyperthyroidism or very large goitres. Occasionally, people whose hyperthyroidism is caused by Graves’s disease may find that their eye symptoms worsen after this therapy. Because of the possibility of exposing young children and pregnant women to low doses of radiation patients, who choose to undergo this therapy, should avoid close physical contact upto 3 to 7 days. This can be difficult for parents of young children. Patients will need to see their clinician on a regular basis after treatment to have thyroid hormone levels checked and monitor for hypothyroidism or recurrent hyperthyroidism. Surgery - it is for those who have a large goitre obstructing the airways, making it difficult to breathe and those who cannot tolerate anti-thyroid drugs, and the individual is fearful of radioiodine. Women who take anti-thyroid drugs and want to become pregnant should discuss this with their doctor. While both the anti-thyroid drugs can be taken during pregnancy and breast feeding, there are potential risks of these drugs in the developing fetus. Propylthiouracil is considered to be safer than Methamazole during pregnancy. Use of radioactive iodine treatment, before conception, usually eliminates the need for anti-thyroid drugs and any possible associated risks. A woman should wait at least six months after radioactive iodine treatment before trying to become pregnant. Women with pre-existing hyperthyroidism and those who are diagnosed with hyperthyroidism during pregnancy can be treated with PTU in addition to a beta-blocker (if needed for symptoms). Blood testing should be performed frequently during pregnancy, at least every four weeks, to monitor the TSH and T4 levels. Due to changes in thyroid hormone levels that occur during pregnancy, TSH and T4 goal levels may be different than goals for women who are not pregnant. The goal of treatment is to maintain the mother’s T4 concentration in the high normal range using the lowest drug dose. There are risks to the mother and fetus if hyperthyroidism is not well controlled; these risks can be avoided or minimised with frequent monitoring and medication adjustment as needed throughout the pregnancy.