Aa
Treatment protocol - Graves
I was diagosed with GD in 1998. I had a RAI-U scan that confirmed GD. I was put on PTU (not sure of the dosage) and was monitored in the anticipation that when I was "normal", I would have RAI treatment. During this time, I moved from the area and discontinued my PTU and my symptoms went away. I did see another doctor regarding RAI and his opinion was that my condition was not severe and that it was up to me if I wanted to have RAI. I chose no. I was not on any ATD after this point (approx. year1999-2000) and had NO symptoms of GD.
During a recent physical I mentioned to my current doctor that I had an elev. heart rate (170-180 bpm) during exercise but that it recovered quickly. He did a TSH, FT4, and TSI
My results:
TSH - .041 (.49-4.67)
FT4 - 3.41 (.7-1.85)
TSI - 1.1
I was put on 50 mg Toprol XL and 5 mg Tapazole 3xday. After one week on Tapazole my doctor called and wanted me to discontinue meds and have another uptake scan so that he can confirm GD diagnoses and rule out thyroiditis. I refused test.
I was retested 6 wks later.
My results:
TSH - .03 (.49-4.67)
FT4 - 2.28 (.7-1.85)
FT3 - 3.80 (2.0-3.5)
I was told me continue on the same dosage of Tapazole and retest in 8 weeks.
My question is this...does this follow the ATD treatment protocol? My doctor has indicated that he does not know alot about GD, but is willing to work with me on the ATDs. He is pushing for RAI, as he said that it is easier for him to control hypo patients with Synthyroid. I have no interest in RAI so I need to educate myself and him on ATDs.
Thank you.
During a recent physical I mentioned to my current doctor that I had an elev. heart rate (170-180 bpm) during exercise but that it recovered quickly. He did a TSH, FT4, and TSI
My results:
TSH - .041 (.49-4.67)
FT4 - 3.41 (.7-1.85)
TSI - 1.1
I was put on 50 mg Toprol XL and 5 mg Tapazole 3xday. After one week on Tapazole my doctor called and wanted me to discontinue meds and have another uptake scan so that he can confirm GD diagnoses and rule out thyroiditis. I refused test.
I was retested 6 wks later.
My results:
TSH - .03 (.49-4.67)
FT4 - 2.28 (.7-1.85)
FT3 - 3.80 (2.0-3.5)
I was told me continue on the same dosage of Tapazole and retest in 8 weeks.
My question is this...does this follow the ATD treatment protocol? My doctor has indicated that he does not know alot about GD, but is willing to work with me on the ATDs. He is pushing for RAI, as he said that it is easier for him to control hypo patients with Synthyroid. I have no interest in RAI so I need to educate myself and him on ATDs.
Thank you.
My understanding from other ATDers test are done every 4 weeks to keep on top of the situation. Some can go hypo very suddenly and you want to be winged from meds before this happens. I know of several who almost went into coma and ended up in the ER.
The remission rates are variable, and relapses are frequent and remission is most likely to be achieved with mild hyperthyroidism and small goiters.
Antithyroid drug treatment is not without the risk of adverse reactions, including minor rashes and agranulocytosis (lack of white blood cells) and hepatitis.
Symptoms are fever or sore throat. Leukopenia, thrombocytopenia, and aplastic anemia (pancytopenia) may also occur. Headache, or general malaise.
Tapazole may cause hypoprothrombinemia and bleeding.
ATDs should be discontinued in the presence of agranulocytosis, aplastic anemia (pancytopenia), hepatitis, or exfoliative dermatitis. Tapazole may cause hypoprothrombinemia and bleeding. You will need periodic test done and probably Bone marrow function should be monitored.
Due to these issues and the fact that your doctor does not know that much about ATD treatment, I'd suggest you go to a endocrinologists who treats many Graves' patient per year or a Thyroidologist.
Nothing wrong with RAI. I did RAI 9 years ago and have no complaints.
Many clinical endocrinologists prefer an ablative dose of radioactive iodine while some prefer a smaller dose that would attempt to render the patient euthyroid. Ablative therapy with radioactive iodine yields quicker resolution of the hyperthyroidism than does small-dose therapy and thereby minimizes potential hyperthyroid-reoccurrences. Radioactive iodine therapy is safe, but most treated patients become hypothyroid and require lifelong thyroid replacement therapy.
It's just a matter of preference and life style on how fast you want to heal and get on with life and living it in good health.
Good Luck.
The remission rates are variable, and relapses are frequent and remission is most likely to be achieved with mild hyperthyroidism and small goiters.
Antithyroid drug treatment is not without the risk of adverse reactions, including minor rashes and agranulocytosis (lack of white blood cells) and hepatitis.
Symptoms are fever or sore throat. Leukopenia, thrombocytopenia, and aplastic anemia (pancytopenia) may also occur. Headache, or general malaise.
Tapazole may cause hypoprothrombinemia and bleeding.
ATDs should be discontinued in the presence of agranulocytosis, aplastic anemia (pancytopenia), hepatitis, or exfoliative dermatitis. Tapazole may cause hypoprothrombinemia and bleeding. You will need periodic test done and probably Bone marrow function should be monitored.
Due to these issues and the fact that your doctor does not know that much about ATD treatment, I'd suggest you go to a endocrinologists who treats many Graves' patient per year or a Thyroidologist.
Nothing wrong with RAI. I did RAI 9 years ago and have no complaints.
Many clinical endocrinologists prefer an ablative dose of radioactive iodine while some prefer a smaller dose that would attempt to render the patient euthyroid. Ablative therapy with radioactive iodine yields quicker resolution of the hyperthyroidism than does small-dose therapy and thereby minimizes potential hyperthyroid-reoccurrences. Radioactive iodine therapy is safe, but most treated patients become hypothyroid and require lifelong thyroid replacement therapy.
It's just a matter of preference and life style on how fast you want to heal and get on with life and living it in good health.
Good Luck.
cmantz2006,
Dr. Mark will be answering soon but in my opinion & I'm not a doctor..................
You are very wise in being leary of RAI. Ceck out this website, please! http://www.geocities.com/ibayoa/index.html
Graves Lady was one of the fortunate few who hasn't suffered after receiving from RAI. If you go to this forum, you will find others including me who have had alot of problems including the onset of thyroid eye disease after RAI. They will answer any question regarding the treament of hyperthyroidism & Graves disease.
http://mediboard.com/groupee/forums/a/frm/f/150103281
It's your decision but please make an informed one. Your future health depends on it. God Bless U, TJ
Dr. Mark will be answering soon but in my opinion & I'm not a doctor..................
You are very wise in being leary of RAI. Ceck out this website, please! http://www.geocities.com/ibayoa/index.html
Graves Lady was one of the fortunate few who hasn't suffered after receiving from RAI. If you go to this forum, you will find others including me who have had alot of problems including the onset of thyroid eye disease after RAI. They will answer any question regarding the treament of hyperthyroidism & Graves disease.
http://mediboard.com/groupee/forums/a/frm/f/150103281
It's your decision but please make an informed one. Your future health depends on it. God Bless U, TJ
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