New Here Questions About My Wifes Graves Disease/dr Wanting To Do Surgery, Or Raigraves disease rai
Posted 14 January 2014 - 05:04 PM
Hi I found this forum last night and I have been reading ever since..So here's the deal a year ago my wife started getting ill her heartbeat was very high 150s we took her to the hospital, tests were ran, and they diagnosed her with Graves. We then went to a specialist, and he made the same diagnosis. She was placed on medication for one year, and during this time she has been mildly stable, her heart rate BP is back to normal, but she is still very moody, restless, then tired.
Right around the 1 yr point the Graves started attacking her eyes, one of them is swollen, the other one droopy. We made an appointment at Vanderbilt hospital in Nashville this is supposed to be the best facility in our location.
This is the results of her lab>>THYROID STIM HORMONE: <0.015* mcunit/mL (0.350-3.600) TSI-QL: 254* % (<=122) F T4: 1.60* ng/dL (0.70-1.37) TRIIODOTHYRONINE, TOTAL: 206* ng/dL (58-160)
She is currnetly taking Methimazole 20 mg daily
Yesterday we took her to have an ultrasound of her thyroid..Here are the results.
The right lobe of the thyroid measures approximately 5.4 x 1.9 x 1.7 cm. There is mild textural abnormality throughout right lobe area there is marked increased vascularity
The isthmus measures approximately 0.5 cm in AP dimension.
The left lobe of the thyroid measures approximately 5.1 x 1.8 x 2.0 cm. There is mild textural abnormality throughout the left lobe and marked increase in vascularity
There is diffuse increased vascularity.
There is no evidence of pathologic regional lymphadenopathy.
1. Diffusely enlarged thyroid with marked increase in vascularity consistent with Graves' disease
The Dr emailed her last night which is very impressive and she said.
"Your ultrasound showed that your thyroid gland is enlarged and very vascular which is most consistent with your diagnosis of Graves Disease. No nodules were noted on the exam. We can discuss these findings in more detail at your next office visit but I wanted to go ahead and notify you of the results."
In a reply I asked the dr which course of action should we take next...She relplied "The result of the ultrasound suggest that either option surgery, or RAI is a good one for you. I would be happy to go through both options with you again in detail at your next visit as these are better discussed in person. www.thyroid.org is a resource where you can find more information about Graves disease, radioactive iodine for Graves disease and thyroidectomy for Graves disease if you would like to do a little reading before your next visit.
So now we're about to go back to the Dr in a week to decide what to do. Could anyone please give us some advice on what to do, and what this all means?
Posted 14 January 2014 - 05:16 PM
Hi and welcome:
If your wife has positive thyroid antibodies and already has eye problems, getting an RAI will make the eyes worst. It sounds like you have been reading up at the Thyroid 101. I suggest if your wife hasn't, to take the 20 mg of MMI (Methimazole) in divided doses of two or three times per day. Also get another thyroid lab done, the Free T3 (Triiodothyrone, Free Serum) which is just as important as getting the Free T4 done.
I am on a very wee doses of MMI for the past 10+ years. Just to let you know that taking an ATD (antithyroid drug) is safe to take in low doses and doesn't generally cause liver problems. I suggest continuing with the MMI and working on getting the FT4 down to mid ranges to the upper third ranges to feel best there at. Eye problems can improve once thyroid levels are corrected.
Posted 15 January 2014 - 09:37 AM
Sorry for the reason you're here but, glad you found us.
80-90% of Graves' patients can look forward to going into remission with anti-thyroid drugs.
I don't understand why your wife's doctor is pushing a permanent treatment after such a short time.
The ultrasound results show that her thyroid is in good shape, albeit enlarged. And, I do wonder
if the enlargement is the result of too much medication. (I'll explain a bit later)
Linda already explained the real and significant risk associated with RAI. And, a large study showed an
increase in cardiac and cancer mortality for post-RAI patients.
Surgery is certainly not without risks, either. The thyroid is attached to the parathyroids which regulate
calcium levels in the body. Parathyroid injury is very real and can be dangerous. There's also the
possibility of thyroid re-growth due to the fact that all tissue cannot be removed.
Both treatments eliminate a vital gland.
With Graves', the thyroid is the victim - not the cause. It's our immune system that is sick. Healing
the immune system is what heals us from Graves'.
20mg methimazole is a pretty hefty dose to be on one year after starting meds. Would you please
let us know if the labs you shared are your wife's starting labs or her most recent ones?
No matter what, I strongly suggest that you hold off on any decisions related to a permanent treatment
until you confirm whether or not the doctor has been medicating properly.
As of right now, I question that.....mostly due to the high dose your wife is taking. After being on meds
for one year, most people take doses ranging from 1.25mg to 10mg with the smaller doses being more
Please understand that a doctor who doesn't know how to medicate with anti-thyroid drugs will not know
how to medicate with the thyroid hormone replacement that has to be taken for life after a permanent
treatment. This can mean a lifetime of misery.
I suspect your wife's thyroid is enlarged because she is overmedicated right now. Her most recent
labs will tell the story....
Posted 15 January 2014 - 09:40 AM
You may be aware of Elaine Moore, author of "Graves' Disease - A Practical Guide".
Elaine maintains a website that is chock-full of great information....much of which is footnoted with
extensive medical references.
You might be interested to read this: