Hyperthyroidism: Radiation vs. Thyroidectomy

[latingntlman]

Hello all, I'm a 43 yr old male with Grave's decease. No nodules thank God, but the size of my gland is pretty huge, I' been taking tapazole for 7 mos. TSH levels are now close to normal, so Dr. said I'm ready for RAI or surgery, but he said there's a shortage of RAI in USA and I'd have to go on waiting list. Now if I elect surgery I'm ready now.  I'm scheduled for surgery June 17, but I have a few concerns and lots of questions. I'm still wondering if I'm rushing into it, or should give RAI a chance first, but Dr. said he doesn't think one round of RAI would be enough b/c of the size of the gland. He thinks surgery is probably best. I've seen two surgeons, one with lots of yrs of experience and over 700 surgeries at Cleveland clinic in FLA. the other and up and coming Dr. in FLA too, who's performed over 70 surgeries. After meeting with both, I picked the younger one b/c he spent way more time explaining of the details of the procedure as well as another procedure before the actual surgery, which is to identify nerves and vocal cords before extracting the gland.  The older surgeon wasn't as detailed.
Other concerns, been married only two years and thinking of babies, is it safe to get my wife pregnant or should I wait til after surgery. Does my sperm count/sex drive become affected by this surgery. Will this cause me to lose my hair. My eyes have bulded out a little bit, will they return to normal.  I could use some good advise.  It's greatly appreciated,

John

[Mark Lupo, M.D.]

There's not a shortage of I-131 at this time (there was in April though).

Is the reason to consider surgery the size?  Graves does not usually need surgery and the size typically decreases with I-131 significantly....may also decrease with tapazole.

I usually treat with tapazole for 12-18 months -- if that is not working...then I-131 unless there is a suspicious nodule (or patient preference) -- then surgery.

The advantage of surgery -- make sure to ask about SSKI prep to decrease blood flow to gland -- is the problem is solved in a day and most patients do quite well.

No definite problems with fertility.  Hair loss may be transient with changes in thyroid levels.

With the eye bulging - I-131 may aggravate this -- would need prednisone to protect the eyes.

[latingntlman]

Dr., thank you for your prompt response.  The reasons for surgery are the following:  The size of it is pretty huge.  I want my eyes to return back to normal asap, and with RAI it make make them worse and cause fribosis.  Also, surgery is a quick, definite procedure vs. RAI.

I do wonder what the following terms mean and their functions:  TSH, Free T4, and T3.  When I compared the last two lab results, they showed the following:
2/28/2007       TSH:  0.01           Low:  0.8          High:  5.50           L
4/25/2007       TSH:  0.01           Low:  0.8          High:  5.50           L
2/28/2007   FreeT4:  1.9             Low.  0.8          High:  1.8             H
4/25/2007   FreeT4:  0.8             Low:  0.8          High:  1.8
2/28/2007         T3:  317             Low:  60           High:  181            H
4/25/2007         T3:  182             Low:  60           High:  181            H

As you can see I think TSH is way TOO low, and that concerns me heading into surgery in two weeks. Should this be a concern?

Last, given my condition, is there such a thing as partial thyroidectomy, meaning leaving a very small portion of the gland inside, and could that portion begin producing enough hormones for that patient not to need hormone medication.

[Lake Lover]

Pick the surgeon with the most experience, like the one with 700 surgeries.

While complications can occur having a highly experienced surgeon reduces those risks.