Hashitoxicosis? Treatment needed?

[kathleen96161]

I am a 36 year old woman recently diagnosed with both a toxic multinodular goiter and hashimoto's thyroiditis.  This all became apparent after some blood tests for infertility (my husband and I have been trying to get pregnant for 14 months with no success).  Anyway, my TSH = 0.01 but my T3 and T4 are both normal.  My TPO antibodies are off the chart.  

I had an ultrasound done, which showed a number of nodules.  The RAI scan showed 3-4 are dominant and are overactive.  A biopsy of the remaining nodules was consistent with Hashimotos.  

I am having no symptoms at all, other than infertility.  I have no compressive symptoms from the goite.  My periods are regular, heart rate is 65, BP is 104/60 at last check.  And, my weight is stable.

My endo is strongly pushing a total thryroidectomy.  This seems a bit rash to me.  First of all, wouldnt RAI be safer in this situation?  And, couldnt I just wait for the thyroid to burn itself out as this is the final endpoint of Hashmitos?   My husband and I would like to to do what is best for me as an individual, not what is best for me and my possibly future fertility.  She does not seem willing to think about me and just is focusing on what she thinks is best to get me pregnant.

Thanks for any input.

[898]

The optional treatment is performed in some thyroid centers involves the ethanol injection into the nodule. This method had been proven to be effective effective for cysts and hot nodules.
Your main goal is to lower the antibodies level that is achieved so far in many cases by taking 200 micrograms of selenium per day.The latter would save the thyroid from complete destruction by antibodies.
The Low dose RAI is effective for people of 45 y.o. and older.

[AR-10]

Surgery is the riskiest option. It is also the fastest and the most effective option.

RAI has it's advantages, but it also has drawbacks. It may not conpletely kill the thyroid. With your hot nodules, it will be hard to get you hypo enough for RAI, and it may not affect the hot nodules at all.

You may have to go through RAI twice. That could take a year or two to see results.

Leaving your gland to die on it's own could take years. Maybe decades. Keeping your levels close to normal would be impossible, and you will swing back and forth between hyper and hypo while you try one medicine after another.

Your body will sustain a lot of damage while that is going on, and it will turn into a horror story of growing nodules, frustration, and medical procedures.

Controlling it with drugs and letting your body kill the gland is the worst option, so reject that plan.

Research RAI and hot nodules, and see what the likely outcome is. I could be wrong, but I don't think RAI will ablate them completely. It really doesn't matter what I think I know, anyway. It is your decision.

Read as much as you can about RAI and how it applies to your condition, and then compare that to the risks of surgery. Surgery has risks, to be sure. Look at the good and the bad of both treatment options and then decide a course of action.

I would opt for surgery, but it is easy for me to say that. I'm not going to have to lay on the surgeon's table and worry about my vocal cords.

I was forced to "choose" RAI, and I would have preferred surgery. RAI was fairly easy other than being off of meds long enough to make me quite ill. But...the Endo said it could take a year to complete the process and get my hormones stable. No one even pretended it would be a success the first time, and I had to sign a release form saying I understood that RAI may give me cancer.

RAI is not better or worse than surgery, in my opinion. It is simply one of two choices. You will have to become educated regarding both procedures and your own medical condition, and decide which option you feel most comfortable with.