Aa
Hyperthyroid treatments
My 77 year old Mother was diagnosed with a hyperthyroid. If she has the iodine treatment, will she have to take a thyroid supplement for the rest of her life? Is taking Tapazole a better option?
HI I have been diagnosed with hyperthyroid do you think i should stop smoking cigarettes?
Not sure if we're allowed to post links, but here it is:
www.geocities.com/ibayoa/ I hope they allow this!
www.geocities.com/ibayoa/ I hope they allow this!
MEDICAL PROFESSIONAL
Given her age, the most likely cause of the hyper is an overactive nodule. See below for details of the different treatments -- in summary if it's a nodule I would use RAI and expect that at least 1 in 4 patients would need lifelong replacement depending on the situation.
There are three ways to treat hyperthyroidism - PTU/Tapazole (anti-thyroid drugs (ATDs)), I-131 treatment (RAI) and surgery.
Usually surgery is a last resort for Graves Disease but is sometimes suggested with over-functioning nodules or with hyperthyroidism in the setting of suspicious nodules.
If you have an over-active (toxic) thyroid nodule, the RAI is preferred over ATDs b/c the ATDs will only work while you are taking them and once stopped you will become hyper-thyroid again due to the toxic nodule. The problem with long-term ATDs is the potential side effects of liver damage, vasculitis and immune system suppression. RAI treatment for an over active nodule directs the radiation to the problem area and decreases the size and function of the nodule(s). The probability of permanent hypothyroidism in this case is roughly 25% depending on the situation -- but I tell patients to expect to become hypo and then if they don't need lifelong thyroid hormone treatment, that's great.
Graves disease can initially be treated with either ATDs or RAI. Graves disease is hyperthyroidism due to an immune system attack stimulating the thyroid to make excessive thyroid hormone. ATDs can be used for 12-18 months and the dose titrated to keep the T4 and T3 in the normal range. Then, if the patient is on a low ATD dose and has normal levels) the medication is stopped - at that point up to 30-50% of patients may stay in remission (ie normal thyroid levels for at least one year). The rate of remission depends on the severity of the hyperthyroidism, the levels of TSH-receptor Antibodies, size of the thyroid and a few other issues (perhaps including smoking status - Graves patients are at particularly high risk if they smoke).
RAI can be used either as the initial treatment of after a trial of ATDs have failed to achieve control or remission. RAI is a single pill taken one time -- it cures Graves Disease 85% of the time after one dose and has very few side effects. The most important side effect is permanent hypothyroidism requiring a daily dose of thyroid hormone replacement for the rest of your life. This is a much easier situation to control however than using ATDs for hyperthyroidism - and without the toxicity to the immune system, liver, and other organ systems that we sometimes encounter with ATDs. There is no increased risk of cancer in Graves patients treated with RAI vs other treatments. There may be some mild nausea or heartburn, but this is transient. In rare cases (< 1%) there may be a painful inflammation of the thyroid after RAI which is sometimes associated with severe hyperthyroidism -- this is transient and can be treated medically. WOMEN WHO MAY BE PREGNANT MAY NOT TAKE RAI AND WOMEN SHOULD NOT BECOME PREGNANT FOR 6 MONTHS AFTER RAI.
An important issue to consider with Graves and RAI is EYE disease. If there is any evidence of Graves eye disease (double vision, eye-aching, swelling, tearing, dryness, inflammation, "bug eyed look", etc) then steroids need to be used in conjunction with the RAI to avoid an increse in the eye disease -- RAI when used in this way is an excellent way to treat the graves hyperthyroidism and the graves eye disease. If there is severe eye disease - this must be aggressively controlled before RAI is considered. SMOKING significantly increases the risk of eye disease.
In summary, RAI works very well in most patients - if after 6 months the T4/T3 levels are still high then the dose may need to be repeated. The hypothyroidism after RAI may occur as soon as 6 weeks - therefore I recommend testing T4 and T3 levels every 6 weeks after RAI to document a trend and intervene early if hypothyroidism develops. The TSH level may take several months to normalize and initially is NOT a reliable way to follow treatment of hyperthyroidism.
There are three ways to treat hyperthyroidism - PTU/Tapazole (anti-thyroid drugs (ATDs)), I-131 treatment (RAI) and surgery.
Usually surgery is a last resort for Graves Disease but is sometimes suggested with over-functioning nodules or with hyperthyroidism in the setting of suspicious nodules.
If you have an over-active (toxic) thyroid nodule, the RAI is preferred over ATDs b/c the ATDs will only work while you are taking them and once stopped you will become hyper-thyroid again due to the toxic nodule. The problem with long-term ATDs is the potential side effects of liver damage, vasculitis and immune system suppression. RAI treatment for an over active nodule directs the radiation to the problem area and decreases the size and function of the nodule(s). The probability of permanent hypothyroidism in this case is roughly 25% depending on the situation -- but I tell patients to expect to become hypo and then if they don't need lifelong thyroid hormone treatment, that's great.
Graves disease can initially be treated with either ATDs or RAI. Graves disease is hyperthyroidism due to an immune system attack stimulating the thyroid to make excessive thyroid hormone. ATDs can be used for 12-18 months and the dose titrated to keep the T4 and T3 in the normal range. Then, if the patient is on a low ATD dose and has normal levels) the medication is stopped - at that point up to 30-50% of patients may stay in remission (ie normal thyroid levels for at least one year). The rate of remission depends on the severity of the hyperthyroidism, the levels of TSH-receptor Antibodies, size of the thyroid and a few other issues (perhaps including smoking status - Graves patients are at particularly high risk if they smoke).
RAI can be used either as the initial treatment of after a trial of ATDs have failed to achieve control or remission. RAI is a single pill taken one time -- it cures Graves Disease 85% of the time after one dose and has very few side effects. The most important side effect is permanent hypothyroidism requiring a daily dose of thyroid hormone replacement for the rest of your life. This is a much easier situation to control however than using ATDs for hyperthyroidism - and without the toxicity to the immune system, liver, and other organ systems that we sometimes encounter with ATDs. There is no increased risk of cancer in Graves patients treated with RAI vs other treatments. There may be some mild nausea or heartburn, but this is transient. In rare cases (< 1%) there may be a painful inflammation of the thyroid after RAI which is sometimes associated with severe hyperthyroidism -- this is transient and can be treated medically. WOMEN WHO MAY BE PREGNANT MAY NOT TAKE RAI AND WOMEN SHOULD NOT BECOME PREGNANT FOR 6 MONTHS AFTER RAI.
An important issue to consider with Graves and RAI is EYE disease. If there is any evidence of Graves eye disease (double vision, eye-aching, swelling, tearing, dryness, inflammation, "bug eyed look", etc) then steroids need to be used in conjunction with the RAI to avoid an increse in the eye disease -- RAI when used in this way is an excellent way to treat the graves hyperthyroidism and the graves eye disease. If there is severe eye disease - this must be aggressively controlled before RAI is considered. SMOKING significantly increases the risk of eye disease.
In summary, RAI works very well in most patients - if after 6 months the T4/T3 levels are still high then the dose may need to be repeated. The hypothyroidism after RAI may occur as soon as 6 weeks - therefore I recommend testing T4 and T3 levels every 6 weeks after RAI to document a trend and intervene early if hypothyroidism develops. The TSH level may take several months to normalize and initially is NOT a reliable way to follow treatment of hyperthyroidism.
I just commented to another poster about this - you may be interested in the International League of Atomic Women website (you can find it by searching on Atomic Women). I wish I had known about it when I had RAI in 2002.....
Thank you for your response, but I can't find the website you mentioned - International League of Atomic Women?
You are reading content posted in the Thyroid Cancer / Nodules & Hyperthyroidism Forum
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
