Hyperthyroidsm: 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 avise.   Appreciated,

John

[pjgovitz]

Hi John,
I just had RAI, if you have RAI you will need to wait at least 6 months after to father a child,  If a real large dose it could be up to a year.I don't believe Surgery would effect this at all.. nor should it interfere with fertility as long as you're on a thyroid hormone replacement....Sounds like you've got great doctors.

Best of luck whichever you chose & God Bless

[latingntlman]

Thanks, pggovitz, that is some very useful information you provided.

may I ask, what made you decide for RAI?

John

[pjgovitz]

I have Hashitoxicosis, that is Graves and Hashimotos both of the autoimmune disease affecting the thyroid. I would swing from hyper to hypo nearly daily. I have Graves with autonomous function, primary Hashimotos. My thyroid would dump an excess amount of hormone on me randomly. I was getting sicker with this, last year I had a bad bout that caused thankfully just minor damage to my heart. It took me 14 years for a doctor to find out what was going on, no one had tested for graves until the past April, my doctor told me this will get rid of the hyper symptoms, (RAI) and it was less risky than surgery...but I am 43 female, and do not plan on anymore children. I would've considered surgery, but he didn't think it was a better option, the RAI is slower to act (he said it would take 2 months for me to feel better) The surgery I think the results are immediate, but there's a chance of damage to the parathyroids, vocal chords, and bleeding... the risks are much lower with an experienced surgeon....Best of luck with what treatment you choose..another good site for Graves info is ......

http://groups.msn.com/GRAVESDISEASEANDRAI/home.msnw


Pam

[pjgovitz]

One more thing...I believe the shortage is over with now on RAI...I had mine within a week of 123 scan, and could've had it the next day, but it had to be put off for one week for a pregnancy test, which is law in my state for women of childbearing years.

[goldgirl]

I had RAI today.  I was offered it 2 weeks ago after diagnosis, but I needed time to arrange chidcare after the dosage.  I do not believe that there is a shortage.  Perhaps it's geographical though (I am in Michigan).  

As far as the treatment goes.  It was really easy.  It is now 4 hours later, and I feel totally normal.

Hope that helps.

[rayneweather]

There are several reasons I decided on TT vs. RAI for multi nodular goiter with underlying Graves.  First - my thyroid was so large that it was visibly noticeable, even to a passerby, and I knew that even if the RAI killed the nodules my thyroid wouldn't get any smaller and would stick out (turns out my thyroid was pushing my airway out of alignment so it's a good thing I did the surgery).  Also, my endo told me that RAI can make Grave's disease worse in some cases and he had a patient whose labs and scans were almost identical to mine have the RAI which caused her Grave's to get worse and she was going to end up with a TT anyway.  The final reason was that a full pathology could be done on my thyroid after the surgery to determine whether I had any cancer.  If I had gone with the RAI I would still have to get scans and fine needle biopsies done for the rest of life with no guarantee that it would catch any cancer early.  For all those reasons I chose the TT and I'm very glad they did.  Even though they found a microcarcinoma it was tiny and my endo is electing not to treat it with radiation at this time.  Hope this helps and that you are comfortable with whatever decision you end up making.

Rayne