can i still take medicine for my graves

[ddd3333]

Have elevated liver profile-lab done jan 3, 07


Alk pho 155 iu/l                                        38-126

t-bil  0.7 MG/DL                                       .2-1.3

sgot   65 iu/l                                              15-40

sgpt     123iu/l                                           10-40


TSH .02l  uIU/ml                                   .34-5.6

FT4   1.72                                             .58-1.64      


I started methiazole 10 mg 2 times a day  on Dec 11,2007

I have an appt on 7 of jan  .   I went in last week to have thyroid blood work  done to take to endo..appt.  I ‘ve felt better but I was itching and had red blotches.   Ask for a liver panel bc  I wanted to know if my liver was ok.. I didn’t expect the results to be elevated.  Now I’m scared. I was told to stop taking the methimzole over the weekend.  did not ask for an explanation of liver panel. was  told numbers were elevated. I see the endo on Monday.  Does this mean medicine is no longer an option??  I really don’t want RAI bc it scares me.  I had one endo tell me to take RAi and he strongly rec it. I've only seen two docs.  I want to give up b/c it difficult to not do what is suggested. I've had the uptake scan but find it had to believe I have graves. Can I take more medicine or do I have to have RAI or surgery?  Thanks for your response  

Here are my lab   Started methimazole 12/10   stopped 1/4

9/20                                                    10/31                              11/20             1/3

TSH .01                                              TSH .01                      TSH .oo   L           TSH .02
FT4  1.39                                            FT4 1.52                     FT4 2.44            FT4   1.72



11/5/07
T3 (total) fzTOTT3 2.30 ng/ml  

[Mark Lupo, M.D.]

The dose of methimazole (40mg total/day) is a high start dose based on recent literature and my experience.  One option would be to lower the dose to 10-15mg per day and see if the side effects of liver abnormalities improve and the rash/itching resolves.  Switching to PTU usually does not help much in these cases and methimazole is preferred over PTU in most cases.  RAI or surgery would be a back-up plan if the liver toxicity persists of the medication is not tolerated.  With graves disease, over 50% of patients ultimately need RAI or surgery due to relapse or intolerance with anti-thyroid drugs.

[Mark Lupo, M.D.]

RAI is rarely an emergency and is not reversible -- but is a very reasonable choice in your situation, so another opinion may give you peace of mind.  The liver numbers are high, but not alarmingly so.  I have seen the liver tests improve with lower doses of tapazole - if they don't then the answer becomes more clear....RAI (or surgery).

[ddd3333]

Thank You for your answer.  The endo kept me off the med. She suggested RAI.  She just would not rec medicine since my liver numbers are elevated. But a dr. on her team ask her if she was going to lower the,med and continue giving it. (He seem to think my liver numbers were not that high.) She didn't respond.  I have been off medicine since Friday Jan 4. Today is the 8th and I'm still itching and have rash/red marks that come and go. Last night my whole back was red. My throat has been sore too. My general dr at the VA is seeing me in the morning.  When I called today to ask the nurse if I could take goodys for my pain , she said no because of my liver numbers.  This is so confuseing- the endo in New Orleans told me that even if I had gone into remission the Graves could come back worse and damage my heart. I'm just about persuaded to do RAI because my endo said no medicine. I'm having my liver checked again on Jan 18.  I may show tell her about your response. Thanks again.  My question is should I keep trying or should I go to another doctor?  

[ddd3333]

Correction - was taking two 10 mg of methimazole twice a day