You might not spend that much time thinking about your thyroid, but it’s doing an awful lot for you. The small butterfly-shaped gland in your neck helps regulate things like your body temperature, heart rate and metabolism.
When you have Graves’ disease, an autoimmune condition that affects five times as many women as men, the body’s immune system mistakenly attacks itself.Certain autoimmune disorders like Graves’ are caused by harmful immunoglobulin G (IgG) autoantibodies. In Graves’ disease, these harmful autoantibodies attack the thyroid and cause it to make more hormones than the body needs, which can cause anxiety, heart palpitations, tremors, severe fatigue, weight loss and other health problems, which can be serious.
Treatments for Graves’ disease haven’t changed much in the last 70 years. But that’s finally changing, with several current clinical trials underway that are testing potential 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 that are currently underway.
Treatment options for Graves’ disease
Antithyroid medications
Treatment for Graves’ disease can vary based on symptoms, individual response and other factors, but Jennifer Cheng, D.O., chief of Endocrinology at Jersey Shore University Medical Center, said her first step is typically medications.
Antithyroid medications can be used to block the thyroid from producing too much hormone but don’t treat the underlying cause of the disease. Methimazole (MMI) and propylthiouracil (PTU) are two of the most common anti-thyroid medications given with Graves’.
Cheng noted that going the medication route first helps because Graves’ disease often comes and goes, and people with Graves’ cycle between periods of improvement and relapse (referred to as flare-ups). In some cases, the thyroid can become hyperactive, then stabilize, and then may return to a hyperactive state. For those patients, medication is ideal because it can be stopped or started as needed.
However, antithyroid medications do not treat the underlying cause of the disease. They also don’t work for everyone. Some people still struggle with symptoms while on medications. And others can’t take them because they have certain conditions, are pregnant or can’t tolerate the side effects. If people stop their medication, they often relapse and start experiencing symptoms again.
Beta-blockers
Beta-blockers can be prescribed in conjunction with antithyroid medications to help manage some of the symptoms that an overactive thyroid causes before the antithyroid medications start working. They do not treat Graves’ disease but can help with symptoms.
Radioactive iodine (RAI) therapy
In cases where medication is no longer effectively managing the condition or medications are not an option for a patient, radioactive iodine (RAI) therapy — also referred to as RAI ablation — can be used.
With RAI, the patient swallows a radioactive pill that, over time, partially or fully destroys the part of the thyroid that produces the hormone. This process can take weeks to months. With that part of the thyroid destroyed, the risk of too much hormone is removed.
There are two caveats to RAI therapy: First, it can’t be used in anyone who has developed thyroid eye disease from their Graves’ disease, because it can worsen the condition, and secondly, it leads to hypothyroidism, when thyroid hormone levels become too low. When that happens, the person needs to go on lifelong thyroid hormone replacement medication.
Surgery
In some cases, surgery to remove the thyroid — either partially or fully — can be the best path for someone who may have a very enlarged thyroid or anyone who is at risk for developing thyroid cancer. However, similar to RAI, removing the thyroid completely eliminates all thyroid function and requires lifelong thyroid hormone replacement therapy.
Emerging treatments
Cheng also provided an overview of some of the newer medications that are under investigation for Graves’ disease treatment and symptom management.
- IMVT-1402: Currently being evaluated in clinical trials for use in normalizing thyroid function in people with uncontrolled Graves’ disease, this treatment is a monoclonal antibody, a treatment that reduces disease-causing autoantibodies. This option could be helpful for people who cannot control their symptoms on antithyroid medications.
- Rituximab: This medication targets certain types of white blood cells and may help reduce relapse rates when used alongside antithyroid medications (called an adjuvant therapy). While not regularly used yet, the combo therapy for Graves’ disease has undergone some exploratory trials.
Other approaches are also being studied that affect immune responses and have the potential to provide additional treatment options for Graves’ disease.
Natural treatments
Healthy lifestyle changes, such as exercise, strength training, and eating a balanced diet that includes plenty of fresh and whole foods, can help support disease management with Graves’ but should not replace surgical or medication-based treatment. According to Cheng, an anti-inflammatory diet may be especially helpful for anyone who experiences inflammation as part of their disease.
“It won’t cure [Graves’ disease],” Cheng said. “You still need the medications and the actual medical therapy, but [an anti-inflammatory diet] would be another means of getting rid of the things that cause inflammation.”
Endocrinologist Paul Sack, M.D., chief in the Division of Endocrinology and Metabolism at MedStar Union Memorial Hospital, warned that any type of “natural” treatment, such as over-the-counter supplements or even diet overhauls, should never be considered a cure-all for Graves’ disease.
“Think really hard about it if anyone says they have a natural remedy for this thing,” noted Sack. “It’s probably too good to be true.”
This educational resource was created with support from Immunovant, a HealthyWomen Corporate Advisory Council member.