Graves or Hyper which do I have and how bad is it?

[Seeker77]

1st blood test results are: TSH    .075,  T3   145,    Free T4   1.91  

3 endo’s, $450 wasted , was rushed out of their office(s) in record 10 mins to be told I am HYPERthyroid, MY ONLY option I-131 RAI. Each endo reluctantly said that for 18-20 months they try, put me on Methimazole 10MG 1X day & Metoprolol 25MG 2x day, I asked what are the prolong side effects of the RAI treatment or the medication. They pulled the ignore and dismiss card on me mighty quick, yet again NO ANSWERS!!!
Refuse to destroy glands, easy for endo, more trouble for patient in the future.
Took Methimazole for 2 weeks with beta blocker felt worse than before. Stopped Methimazole due to extreme itching, hair loss that would not dissipate.  2nd of my blood test results from hospital clinic:
TSH    <.01  Free T3   5.74  Free T4   2.0 Antithryoid Antibodies:
Thyroglobulin   <60   111   Thyroid Peroxidase  <60   91

Have new appt for new endo @ hospital enodcrine teaching clinic for mid Oct 2007, I’m on beta blockers 2X day, could I end up in thyroid storm b4 this appt or will beta blocker tide me over till then?
ATD meds, could I ruin my liver, kidneys, whether med is PTU or Methimazole (are there any other meds like this other than these 2?) RAI, can it be done in hospital? Very tired of RAI treated patients telling me they REGRET being FORCED into treatment. Spoke to numerous patients who say they prefer being  HYPER than HYPO any day because their endo’s can’t get their dosages of Synthroid straighten out’. No guarantee I could have residual side effects, risk of cancer, Synthroid dosage given wrong after RAI to even affect my liver, kidney, bone marrow problems, etc…all this damn risk?

[Seeker77]

OK which ATD med PTU/ Methimazole/ Carbimazole gets better results for a hyperthyroid/Graves patient go into remission faster? Does it matter if I take name brand or generic version of ATD’s to have more longer lasting effective remission rate? How long does remission on any of these ATD last (months or years)? How long b4 I can stop taking Metoprolol with ATD?
Is Methimazole in smaller doses more effective in assisting a HYPERthyroid/Graves manage their Thyroid levels and help the person get into remission for a longer time? Or is PTU better when taken in more higher doses to avoid any toxic liver/kidney problems? Can my blood test determine how much damage is being incurred on my liver or kidney or will taking brand name ATD be better in helping me avoid any toxicity/ill side effects like feeling lethargic, losing hair, and itching very badly (does the itching subside after the ATD Methimazole is taken after a month or so or would it be better to divide 10 MG into 2 to control itchiness?

Are there any patients who have been able to successfully live off of either ATD and if so how harmful are the ill side effects depending on how long you have taken ATD’s compared to having RAI done?

Are there any side effects after remission and how many times after that do you have to have blood tests done before or after remission?

Also, what kinds of food am I ALLOWED or NOT ALLOWED to eat? Not eating so much, on extreme bland diet, feel anxious around food. Seeking food list for hyperthyroid/graves type patients, can’t find one anywhere, don’t want to trigger hyperthyroidism with wrong foods? Are all sweets a no no when they have soy lecithin or soy anything? Are fast foods banned for me, use to enjoy grill sliced steak and a small plate of fries once in blue moon at favorite restaurant now extremely terrified of going near there for fear of driving my cholesterol up (cholesterol is OK just saying).

32 & very concerned about decision made. Thanks for responding back Dr.Lupo.

[Mark Lupo, M.D.]

You have Graves Disease.  RAI is irreversible and I try not to force patients into it but it is a very effective treatment and despite what you read on the internet most patients do fine with synthroid treatment (if the TSH is kept in appropriate range -- 0.5-2.0, unfortunately this is not always done).

Being hyper long-term has large risks to the heart and bone, so that is not a good option.  Your levels reflect mild-moderate hyperthyroidism but getting worse than the first set.  

Options - rechallenge with methimazole vs try PTU vs surgery vs RAI.  I usually offer ATDs for 12-18 months and if not effective, side effects or toxicities then go to I-131 (or surgery if patient prefers, but I still feel that may be too invasive for most Graves patients).  So about 60-70% of Graves patients may ultimately need I-131 or surgery as the remission rate with ATD's is about 30-40%.  Many endos go right to I-131, this is fine and acceptable, but I see too many patients who resent this approach.

Beta-blockers (metoprolol) are important throughout this.  risk of storm is very low, but keep an eye on heart rate -- resting should be kept below 90.