Why do people choose rai and then deal with the risk of being hypo? Are the drugs safer with hypo? ie synthroid vs. ptu? I've just recently been diagnosed with graves disease (subclinical hyperthyroidism 0.1 tsh, normal t4..) I am trying to get pregnant and endo recommended ptu 150 mg. I asked about rai just for my own info and i was shocked that he actually considered it and said if i wanted to do that i could. it seems crazy to do that aggressive treatment for subclinical hyper in my own lay person opinion. what gives... are there advantages to being hypo over hyper?
As long as we are on meds.with levels normal and stable, we are neither hypo or hyper.
Some of us have to with no other choice. With thyroid disorder the thyroid will eventually burn itself out and some believe in having it burn out now with RAI rather than latter, which avoids lots of symptoms and misery. In other words, they can get on with their lives.
RAI is faster and safer. Doing RAI you can get pregnant when levels become normal and stable which normally is between 6 to 12 months after treatment. There is no side effect or danger to the fetus or baby and with thyroid meds. its safe to nurse.
Radioiodine treatment given at least six months before conception can eliminate the need for antithyroid treatment during pregnancy.
With PTU, Clinicians usually recommend one to two years of PTU drug treatment followed by re-evaluation.
Recurrence can occur within 10 days of stopping PTU treatment, or it can occur several years later. If levels of T3, T4, and TSH remain normal for 12 months you are considered in remission. Relapse after this time does occurs in a lot.
There is evidence that PTU may cause harm to the fetus during pregnancy. If hyperthyroidism becomes more severe during pregnancy, however, PTU may be considered useful under physician supervision. There is evidence that PTU may cause harm to the fetus during nursing. PTU can cause a temporary goiter and hypothyroidism in the developing fetus. Use of PTU while nursing should be done under careful physician supervision.
Serious side effects have occurred with PTU therapy. A decrease of white blood cells in the blood (agranulocytosis) may occur. Symptoms and signs of agranulocytosis include infectious lesions of the throat, the gastrointestinal tract and skin with an overall feeling of illness and fever. A decrease in blood platelets (thrombocytopenia) also may occur. Since platelets are important for the clotting of blood, thrombocytopenia may lead to problems with excessive bleeding.
There also have been rare occurrences with PTU of hepatitis and death of liver cells (hepatic necrosis). Failure of the liver due to hepatic necrosis may lead to severe brain swelling, gastrointestinal bleeding, and death.
Also, PTU also interferes with the conversion of T4 to T3,
There are draw backs to all the treatments and a matter of preference. However, you should base your treatment on your thyroid condition and by the one that best fits your needs such as life style and goals.
I am regreting having the RAI. I was severely hyper thyroid (Hyper storm) back in 2004. I wish I would of done some checking before I trusted a "quick" decision doc to have my Thyroid burnt out. Looking back my levels were getting better on treatment for Hyper Thryroid but I was not aware at the time. I went through the RAI and now I have no thyroid at all. If I could go back I would of continued treatment and if it would of burnt out naturally I think that may of been a better choice for me. I at the time was not wanting to get pregnant. You are sub clinical at this time. Make sure you explore all your options before you choose.
I still have some thyroid function. I take thyroid medication to composite for the
non-functioning part of my thyroid cells that RAI radiated or destroyed.
It is assumed that the ablative dose of RAI destroys all or most of the thyroid tissue, however it may not. It may destroy just enough to assure that you are no longer hyperthyroid, but there can still be significant thyroid tissue left. The remaining tissue can be stimulated to produce more excess hormone by increases in antibody action, and can also eventually be destroyed by antibody action. The normal progression of the disease is for the antibodies to wear the thyroid cells out over time.
The dose amount of RAI given depends on the doctors and how severe the thyroid condition. Some doctors try to adjust the dose of radioactive iodine to destroy only enough of the thyroid gland to bring its hormone production back to normal, without reducing thyroid function too much; others use a larger dose to completely destroy the thyroid.
Radioactive iodine works by destroying the thyroid cells that are hyperfunctioning or sick or cancerous. Normal thyroid cells are less likely to take up excess exogenously administered iodine. Higher the dose the more sick thyroid cells are destroyed to where total thyroid cells are destroyed rendering 100% non-functioning thyroid i.e. 100% hypothyroid.
Thyroid medication dose can relate to approx. how much thyroid function and/or if thyroid is totally non-functioning.
I don't regret my upcoming TT. My levels are lowering with meds, but not enough. They are still in the high range. My endo said medication isn't an option for me, my levels will never get low enough to be stable. I opted for TT because of the nodules growing on my thyroid.
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