Managing Hyperthyroidism: Medication Side Effects and Surgical Options

Hyperthyroidism

Hello! When I was 18 years old, I was diagnosed with hyperthyroidism and goiter.
After taking medication for six months, it was controlled! However, at 21, I found out that it had relapsed.
A different doctor prescribed me Tapazole and Propranolol, to be taken twice a day, three tablets each time.
However, after taking them, I developed a lot of acne on my face, which doesn't look like typical teenage acne.
Now that I have finished the medication, I haven't continued taking it, and my acne has improved somewhat, but it is still quite severe.
I would like to ask what I should do in this situation.
Some people have suggested that surgery might be a better option since my goiter is quite noticeable.
Is surgery a good idea, or should I avoid it? Thank you.

Yu Ting, 20~29 year old female. Ask Date: 2003/06/05

Dr. Yang Hongzhi reply Internal Medicine

The likelihood of a relationship between acne and antithyroid medications seems low.
Surgical treatment for hyperthyroidism is one option; however, surgery is generally not directly recommended unless there is significant thyroid enlargement or the presence of a tumor.
If you are not keen on taking medication, you may also consider radioactive iodine treatment.
Each treatment option has its advantages and disadvantages, so it is best to discuss with your physician before making a decision.

Reply Date: 2003/06/05

More Info

Managing hyperthyroidism can be a complex process, especially when considering the side effects of medications and the potential need for surgical intervention. In your case, it appears that you have experienced a recurrence of hyperthyroidism after initially being treated successfully. The medications you mentioned, Tapazole (methimazole) and Propranolol, are commonly used to manage hyperthyroidism. Tapazole works by inhibiting the production of thyroid hormones, while Propranolol is a beta-blocker that helps manage symptoms such as rapid heart rate and anxiety.

Medication Side Effects
It is not uncommon for individuals taking Tapazole to experience side effects, and skin issues such as acne or rashes can occur. The appearance of acne-like lesions on your face may be related to the medication, but it is also possible that other factors, such as hormonal changes or stress, could be contributing to this issue. It’s important to discuss these side effects with your healthcare provider, as they may consider adjusting your medication or prescribing an alternative treatment that may be better tolerated.

In addition to skin issues, other potential side effects of Tapazole can include:
- Liver dysfunction: Regular monitoring of liver function tests is recommended.

- Agranulocytosis: A rare but serious side effect where white blood cell counts drop, increasing the risk of infections.

- Allergic reactions: Some patients may experience allergic reactions, which can manifest as skin rashes or other symptoms.

Propranolol can also have side effects, including fatigue, dizziness, and gastrointestinal issues. If you are experiencing significant side effects that impact your quality of life, it is crucial to communicate this with your doctor.

Surgical Options
Surgery, specifically a thyroidectomy (partial or total removal of the thyroid gland), is an option for patients with hyperthyroidism, especially if medications are not effective or if there are concerns about the size of the goiter (enlarged thyroid). The decision to pursue surgery should be based on several factors:
1. Severity of Symptoms: If your hyperthyroidism is causing significant symptoms that are not well-controlled with medication, surgery may be a viable option.

2. Size of the Goiter: If the goiter is large enough to cause discomfort or difficulty swallowing, surgical intervention may be warranted.

3. Response to Medication: If you have had recurrent hyperthyroidism and have not responded well to medication, surgery may provide a more permanent solution.

4. Patient Preference: Some patients prefer surgery to avoid long-term medication use and its associated side effects.

Conclusion
In summary, managing hyperthyroidism involves a careful evaluation of medication side effects and the potential need for surgical intervention. It is essential to have an open dialogue with your healthcare provider about your symptoms, side effects, and treatment options. If you are experiencing significant side effects from your current medications, it may be time to discuss alternative treatments or the possibility of surgery. Each case is unique, and your healthcare team can help you weigh the benefits and risks of each option to determine the best course of action for your health.

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