[Expanded therapeutic possibilities in hyperthyroidism in the elderly. Sclerotherapy of autonomous adenomas and...

Patients with Graves' or Plummer's disease have usually definitively been treated by surgery or radioiodine. If, however, the patient does not accept either form of treatment or the risk of surgery or the inconveniences 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, whether any treatment is necessary at all: Small compensated autonomous adenomas with euthyroidism must not be eliminated in every case, the same applies for cases of remaining subclinical hyperthyroidism after radioiodide or surgery if the amount of remaining functional tissue is small. 2) Isolated autonomous adenomas may, under certain conditions, be eliminated by alcohol injections. This novel approach should be considered particularly for elderly patients, since it can be done on an outpatient basis. 3) For very old and very frail patients a continuous and lifelong medical treatment represents and adequate alternative to surgery 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.