Prednizone and Nexium use in Hyper patients

[Taylia]

I am severely hyperthyroid and have acute thyrotoxicosis (I carry a note with me regarding the possibility of thyroid storm should I present at the ER).  My endo says I am the worst case he's seen in 3 yrs plus.  I was prescribed 1 x Inderal 40 (beta blocker) and 5 x Neo Mercazole (25mg) three times per day.  I was on this regime for 6 weeks in total and my blood test results haven't changed beyond the normal fluctutations.  My endo has suggested I try adding Prednizone 30mg per day and Nexium (which he assures me will help the reflux and heartburn that has been causing me to throw up 30-odd percent of the previous regime).  He suggested Lithium as another option but ultimately decided on the Prednizone because he wasn't sure what effect the Lithium might create when added to Neo Mercazole.  He tells me that he has had great results with Lithium (apparently recently tried as a replacement for Neo Mercazole in a patient who was allergic - Manic Depressives who are prescribed Lithium sometimes end up with Hypo apparently and so the connection was made, yes?)

Anyhow, what I rerally want to know is: given the massive side-effects (kidney failure - scary!) associated with Prednizone, should I be nervous about taking it?  Does this approach really have a decent success rate, and how does that work if so?

I am also nervous at the sheer amount of pills required here - 30 per day!!!

[Mark Lupo, M.D.]

It depends on the cause of the hyperthyroidism - did you have an I-123 uptake/scan to document graves vs thyroiditis -- that lack of response to neo-mercazole is concerning but possible in Graves.  If it is Graves you will likely need I-131 (radio-active iodine) for definitive treatment.  The lithium can trap iodine in the thyroid and is useful in extreme cases but is usually used in conjunction with radioactive iodine to make it more effective.  The prednisone will decrease the T4 to T3 conversion and is useful in thyroiditis to help with pain -- but is only modestly helpful in Graves -- it is part of the treatment protocol in storm.  The nexium is helpful to enable you to tolerate all the meds you take!  

If you have graves and are not planning I-131 then SSKI (super-saturated potassium iodine) can be used to block the thyroid's uptake of iodine and decrease function.  

Good Luck.

[Taylia]

PS.  I am only 26!! I am trying to avoid radioactive iodine because I have a baby son and a small daughter as well.  Is my age outside the normal bracket?

[ancientmariner]

I had RAI in 2002, and have regretted it ever since, mainly because my doctors have failed to treat the resulting hypothyroid condition properly to allow me to feel well. Please do not agree to having RAI until you have exhausted all other possibilities. And please ask your doctor to test your antibodies, both TPO and TSI, to verify whether you might have Hashimoto's disease instead of Graves'. Research as much as you possibly can before making a decision of RAI!

[Cabo513]

A related discussion, Prednizone was started.