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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
Hyperthyroid
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.
Hyperthyroid
by mytvitvan, Jan 28, 2008 12:54PM
My twins daughters are being treated with Grave desease with Tapazol for several years now. Twin1 was diagnosed at age 11 and twin2 at 12. They are now 19 yrs old. Twin1 was in remission for about 2 years and a year ago, Grave desease came back and she is now on Tapazol again. Twin2 is still continue to take the medication. Both of my twins are in at the Universtiy and they are doing very well in school when the Hyperthyroid is under control. When their grades started to slip, then they know that the Hyperthyoid is acting up again due to unable to stay focus and being tired. Recently, their Endo. recommended that they should have RAI, that way they don't have to worry about it anymore while in school. My concern is that they are only 19 yrs old, and this treatment sound very scary to me. The Endo said RAI is very safe and they will need to take thyroid medication for the rest of their lives. She said they will eventually be hypo. Do you think they should have the RAI at this age so young? Does being Hypo is easier to control than Hyper? Will they gain weight due to hypo?
Their recent blood tests... Twin1, (10mg tapazol once a day)...Free T4= .85, TSH =13.20, T3 Total = 112. After this report, her Endo said she is a little hypo and reduced her med to 10mg every 2 to3 days. I wonder why her Endo still wants her to take the 10mg of tapazol even she is a little hypo? Twin2, (15mg tapazol once a day) FreeT4=.80, TSH=1.09 T3Total=130, after this report, her Endo reduced to 10mg a day. Is my twin2 still a little hyper?
Thanks.
PC
Their recent blood tests... Twin1, (10mg tapazol once a day)...Free T4= .85, TSH =13.20, T3 Total = 112. After this report, her Endo said she is a little hypo and reduced her med to 10mg every 2 to3 days. I wonder why her Endo still wants her to take the 10mg of tapazol even she is a little hypo? Twin2, (15mg tapazol once a day) FreeT4=.80, TSH=1.09 T3Total=130, after this report, her Endo reduced to 10mg a day. Is my twin2 still a little hyper?
Thanks.
PC
Doctor's Answer
by Mark Lupo, M.D., Jan 29, 2008 06:15AM
, Jan 29, 2008 06:15AM
With this history, the likelihood of coming off tapazole completely is low -- as they have had Graves with recurrence or persistence for 7-8 years.
RAI is almost never an emergency - and is not reversible. Patients tend to gain weight no matter how the hyper is controlled (tapazole, surgery or RAI). Hypothyroidism tends to be easier and safer to treat than using tapazole to control hyperthyroidism, tapazole is associated with liver toxicity and immune system suppression -- both rare, but important considerations if one must be on this medication long-term.
Twin1 w/ TSH of 13.2 was certainly hypo -- would prefer a 5mg dose daily (1/2 10) over 10mg every 2-3 days.... Twin2 was low-normal in terms of T4/T3, and a decrease to 10mg is ok.
RAI can increase the risk of Graves eye disease -- so if they chose this, make sure there is no eye symptom before hand.
There is some data suggesting that long-term, carefully monitored, low dose (2.5-5mg/day) tapazole is safe (the data followed patients for 10 years).
The other option is surgery, but this is considered more invasive than RAI.
RAI is almost never an emergency - and is not reversible. Patients tend to gain weight no matter how the hyper is controlled (tapazole, surgery or RAI). Hypothyroidism tends to be easier and safer to treat than using tapazole to control hyperthyroidism, tapazole is associated with liver toxicity and immune system suppression -- both rare, but important considerations if one must be on this medication long-term.
Twin1 w/ TSH of 13.2 was certainly hypo -- would prefer a 5mg dose daily (1/2 10) over 10mg every 2-3 days.... Twin2 was low-normal in terms of T4/T3, and a decrease to 10mg is ok.
RAI can increase the risk of Graves eye disease -- so if they chose this, make sure there is no eye symptom before hand.
There is some data suggesting that long-term, carefully monitored, low dose (2.5-5mg/day) tapazole is safe (the data followed patients for 10 years).
The other option is surgery, but this is considered more invasive than RAI.
Member Comments (1)
by Maggles_672, Jul 18, 2009 11:48PM
A related discussion, Need Help was started.
