ALTERNATIVE THERAPEUTIC APPROACHES FOR HY PERTHYROIDISM IN OLD-AGE - PERCUTANEOUS ALCOHOL INJECTION AND LIFELONG SMALL-DOSE MEDICAL-TREATMENT

Patients with Graves' or Plummer's disease have usually definitively b een treated by surgery or radioiodine. If, however, the patient does n ot accept either form of treatment or the risk of surgery or the incon veniences of the radioiodine treatment by far out-weight the expected benefit for the patient, alternative therapeutic approaches should be explained and been offered to the patient: 1) It must be clear, whethe r any treatment is necessary at all: Small compensated autonomous aden omas with euthyroidism must not be eliminated in every case, the same applies for cases of remaining subclinical hyperthyroidism after radio iodide or surgery if the amount of remaining functional tissue is smal l. 2) Isolated autonomous adenomas may, under certain conditions, be e liminated by alcohol injections. This novel approach should be conside red particularly for elderly patients, since it can be done on an outp atient basis. 3) For very old and very frail patients a continuous and lifelong medical treatment represents and adequate alternative to sur gery and radioiodine. Small amounts of carbimazole or methimazole in a single daily dose combined with small amounts of thyroxine may safely control the hyperthyroidism, again on outpatient conditions.