# Why Are there only 2 choices - I don't like either



## redridgie (Apr 27, 2010)

I was diagnosed with Graves disease a little less than 2 1/2 years ago. Endo put me on methimizole and gradually decreased the dose for the next year and 4 months until he stopped the medicine altogether. Now my symptoms are back and I'm back on the methimizole. Endo recommends either RAI or surgery.
Really neither of those options is acceptable to me. I envision that my levels will ebb and flow, throughout my lifetime, and I don't understand why it can't be managed like that. In other words, why can't it simploy be controlled through medication when needed. I understand that I will need to listen to my body and be tested from time time. 
Can someone please explain why medication is not recommended as a long term solution?


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## GD Women (Mar 5, 2007)

If you don't opt for a permanent treatment you could cause serious health issues and chance of thyroid storm or death. Before there was a treatment 50% thyroid patients died from Graves'.

Evidence suggested only 12-18 months of anti-thyroid drug treatment should be used because long term use of these meds. can cause irreversible damage such as to the liver. Antithyroid drugs "usually do not cure the patient" and have "rare but potentially life-threatening" adverse effects including inhibition of bone marrow function (agranulocytosis, granulocytopenia, aplastic anemia, thrombocytopenia), drug fever, a lupus-like syndrome, insulin autoimmune syndrome (can result in hypoglycemia coma), hepatitis, inflammation of arteries, decreased level of prothrombin (for blood clotting), and more.

Randomized clinical studies shows some evidence that pre-treatment of patients with either Graves' disease or toxic goiter with antithyroid drugs reduces the effectiveness of the subsequent radioactive iodine treatment and results in more severe transient rebound hyperthyroidism, compared to patients who received radioactive iodine without pretreatment. A higher dose of radioiodine will be needed because of the induction of radioresistance by antithyroid drugs administered after, and possibly before , radioiodine therapy. With appropriate adjustment of the radioiodine dose, however, the cure rate should be unaffected 
Radioactive iodine treatment has been safely used on millions of people for more than 60 years. Radioactive iodine (RAI) is often chosen for treatment of hyperthyroidism (overactive thyroid) because of its simplicity and it is given in a single dose. Another plus for RAI is its lack of side effects. Even a third dose of radioiodine can be easily given without side effects. Radioiodine treatments cure hyperthyroidism, lower thyroid hormone levels, and thus cause symptoms to disappear. Weight gain is not an inevitable consequence of treatment. RAI treatment is based on the fact that the thyroid actively accumulates iodine, which it uses to produce thyroid hormones required for normal body function. RAI is like the iodine found in foods such as fish, seaweed, and iodized salt, except that it releases an electron, or beta particle, which creates its therapeutic action.

In a total thyroidectomy, nearly all of the thyroid tissue is removed. It's impossible to remove every bit of tissue because some tissue is affixed to the parathyroid glands and adjacent organs. So, Surgeons tend to leave a portion of the thyroid intact, in order to avoid damaging parathyroid's or the nerve that runs through the thyroid that works the vocal chords. Even with the most meticulous surgery, small amounts of thyroid tissue are often left behind to help preserve the integrity of critical structures that lie beneath the lobes of the thyroid.

After surgery thyroid levels can fluctuate. Thyroid antibodies can persist in the blood circulation for 2-3 months and can cause effects on residual thyroid tissue, and thyroid tissue cells in which thyroid tissue can grow over time. It is important to have thyroid function tests done every month after surgery for at least the first six months. When levels are stable then thyroid function tests can be done every six months.

With residue tissue left, antibodies can still attack and/or there is a chance that the thyroid can grow back. In the case of thyroid cancer, RAI treatment is done after surgery to kill off the residue tissue that is left to avoid the chance of re-growth and cancer reappearing

An option might be Endoscopic surgery which is a procedure where several small incisions are made, through which a tiny camera and instruments are passed. The surgeon uses the endoscope to guide the instruments in removing the thyroid. 
Endoscopic surgery requires less recovery time and causes smaller scars but is not appropriate in all cases. 
The length of your hospital stay and your recovery depend on such factors as your age and general health, the extent of the surgery, and whether cancer is present. However, many people leave the hospital a few days after surgery.

These are your option and thank God we have them.

Your choice - your body - your life!


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## Andros (Aug 26, 2009)

redridgie said:


> I was diagnosed with Graves disease a little less than 2 1/2 years ago. Endo put me on methimizole and gradually decreased the dose for the next year and 4 months until he stopped the medicine altogether. Now my symptoms are back and I'm back on the methimizole. Endo recommends either RAI or surgery.
> Really neither of those options is acceptable to me. I envision that my levels will ebb and flow, throughout my lifetime, and I don't understand why it can't be managed like that. In other words, why can't it simploy be controlled through medication when needed. I understand that I will need to listen to my body and be tested from time time.
> Can someone please explain why medication is not recommended as a long term solution?


Welcome to the board. Our Super Mod GD Woman has given you an wonderfully concise and informative answer.

Long-term use of anti-thyroid med tends to destroy the liver. If you are on such medicine, your doctor should be checking the liver enzymes about every 3
months at least.

You know your body, you know your life-style and hopefully you know your goals so you have to make the decision that is best for you. We won't influence that one way or the other.

Our job is to provide information, succor and support.


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## hillaryedrn (Dec 14, 2009)

Yes, indeed, wonderful information already given!! I completely understand you not wanting to have drastic measures taken. Do think about all the information given to you. This really is a very serious situation. We're all here for you, tho, if you need us!


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## GD Women (Mar 5, 2007)

OOps! I forgot to list RAI as an option treatment - here it is:

The doses of radiopharmaceuticals will be different for different patients and for the different types of treatments.
In Hyper/Graves' it is a very minimal dosage. Radioactive iodine treatment has been safely used on millions of people for more than 60 years. 
It is (RAI) often chosen for treatment of hyperthyroidism (overactive thyroid) because of its simplicity. it is given in a single dose. Another plus for RAI is its lack of side effects. RAI treatment is based on the fact that the thyroid actively accumulates iodine, which it uses to produce thyroid hormones required for normal body function. RAI is like the iodine found in foods such as fish, seaweed, and iodized salt, except that it releases an electron, or beta particle, which creates its therapeutic action. The radioactivity is mostly in the form that can only travel very short distances of 2 mms. or so. This is less than one eighth of an inch. It does not even damage structures next to the thyroid gland itself.

There are no immediate side effects from radioiodine treatment. Even a third dose of radioiodine can be easily given without side effects. Radioiodine treatments cure hyperthyroidism, lower thyroid hormone levels, and thus cause symptoms to disappear. Weight gain is not an inevitable consequence of treatment.

http://tech.snmjournals.org/cgi/content/full/34/3/143

http://www.endocrinologist.com/Radioactive.html


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