Thyroid Storm?

[Smilerdeb]

I am considering having RAI as I have Graves and Hyperthyroidism which hasnt been successful to manage with Carbimazole due to drug sensitivity. Two weeks ago, I had a Supraventricular Tachycardia Fibrillation (I have a heart murmur from birth and trivial and mild regurgitation of mitral and tricuspid valves).
What I need to know is.....
Is there a BIG possibilty of me getting thyroid storm after RAI as the last episode of fibbrillation made me feel like I was going to die. I have been checked by my Cardio since and ultraosund shows no clots or damage and same results as from ultrasound 2 years ago.
This worry of thyroid storm is the only thing stopping me have RAI.
Please help with any input you can.

[GravesLady]

I have had heart murmur since birth and diagnosed with MVP as an adult, in fact the same time that I was diagnosed with Graves'.  I have always remembered heart palpations especially at night in bed, making for a noisy world. Since I had RAI the
palpations have disappeared and the world has become still and quiet. In the beginning this concept of a still and quiet world was just amazing to me. I had no problems with RAI.  Thyroid storm is very rare.  However, approx a week or two after RAI the body will be getting rid of extra stored thyroid hormones, not producing hormones, but stored, in which there may be hyper symptoms experienced, not a storm! and in which only last approx a week.  If you are aware of this and are careful not to exert yourself like cardio exercising or stressors, as not to tax your system any more than necessary, you should be ok. I don't remember going through this myself. However my blood pressure shot up, so doctor put me on Inderal and I was only on it until next doctor appointment 4 weeks later. I have had no direct or indirect issues with RAI and it is going on 12 years.  Good luck with your decision.

GL

[Mark Lupo, M.D.]

There is a small risk -- would make sure you are on beta-blockers.  Also if you have any sign of thyroid eye disease, it will be important to be on prednisone (which would also help decrease the risk of storm).  Another option would be thyroidectomy (surgery) with pre-treatment for 10days with SSKI drops and beta-blockers (pre & post surgery).  The advantage to surgery is immediate resolution of hyperthyroidism and essentially no increased risk of aggravating/causing thyroid eye disease.  RAI remains the treatment of choice in the US and close monitoring/beta-blockers are key to avoiding problems.