Some innovative practitioners recommend a technique known as block replace therapy (BRT), which involves simultaneous use of antithyroid drugs to disable the overproduction and thyroid hormone replacement to suppress function and provide sufficient thyroid hormone. According to experts, the majority of patients do become hypothyroid for life after RAI, and while this is sometimes due to radiation-induced follicular damage, there are suggestions that this promotion of antibodies worsens the underlying thyroiditis and causes hypothyroidism. RAI is typically followed by an elevation in thyroid antibodies, which can further aggravate the autoimmune-related symptoms. The iodine concentrates in the thyroid, making it partially or fully inactive, and reversing the hyperthyroidism. In RAI, a radioactive iodine pill is given. Despite the fact that patients treated with antithyroid drugs have a decent chance of permanent remission, radioactive iodine (RAI) is the treatment of choice in the United States. However, a lowered white count will return to normal once you have stopped taking the drug. If the white count has been lowered and you continue taking the drug, the infection could become fatal. The doctor will likely tell you to stop taking the drug right away and get a white blood count that same day. If you experience an infection while taking these drugs, call your doctor immediately. In very rare cases, these cells may disappear entirely (a condition called agranulocytosis), which can be potentially fatal if there is a serious infection.

A rarer and even more serious potential side effect is a decrease in the white blood cells that are part of the immune system, thereby resulting in a decrease in resistance to infection. In about 5% of cases, antithyroid drugs cause allergic reactions such as skin rashes, hives, and sometimes fever and joint pains. This is another reason to see your doctor early if you suspect you have the disease. One is vocal cord paralysis. There are several somewhat rare complications resulting from the surgery. If all or part of the thyroid is surgically removed, hypothyroidism is still a strong possibility. If too much is taken, then the patient can become hypothyroid. Determining how much of the gland to take is part science and part art. While the goal of surgery is to remove just enough of the gland so that thyroid production is normal, it's not often achieved. This surgery involves removal of all or part of the thyroid gland and can typically provide a permanent cure for hyperthyroidism. In the United States, thyroidectomy is typically done only when the patient cannot tolerate antithyroid drugs or is not a good candidate for RAI (such as in a case of life-threatening hyperthyroidism during pregnancy).