[cynna]

#1058824

I was diagnosed with Graves almost 4 years ago. I recall reading this board an awful lot back then, and seemed to me that wherever I researched, it always said you should be on meds for approximately 18-24 months after first being diagnosed. I am still taking methimazole, and my endo says I can take it until the year 2058 (he liked his little joke) as long as I am not sick. I also read so much about RAI and surgery, and how people struggle over the decision which to choose. I too struggled with that at the beginning, but my doctor said that if the meds didn’t work, then I will need RAI. So I am wondering if there is a large majority of people that are on meds that you just don’t hear about, or is it not good to be on this medication for so long?

[Kimberly]

#1170208

Hello – The latest guidelines from the American Association of Clinical Endocrinologists and the American Thyroid Association state that the “standard” course of treatment with Anti-Thyroid Drugs is 12-18 months. However, the guidance notes that “Low-dose methimazole treatment for longer than 12–18 months may be considered in patients not in remission who prefer this approach.”

Personally, I’ve been on methimazole for 4+ years now. The primary concern that I hear from doctors about long-term use is that the side effects can be “idiosyncratic” and can potentially occur at any time. However, side effects are *much* more likely to occur at high doses of the meds and early in the treatment process. So this is a decision that you will need to make after weighing the pros and cons of all three options.

Take care!

[Ski]

#1170209

Hi Cynna,

One thing I think you ought to know is related to the fact that the research shows the more serious side effects (as Kimberly mentioned) occur most often at the very beginning of treatment, or on high doses.

If you stop taking the ATDs for a significant period of time, then start taking them again at some point, you have to define that as another “beginning of treatment,” so the risk of the more serious side effects is again an issue to consider (no matter the fact that you’ve already had a successful course of treatment with them).

Just something to consider as you navigate the process…

Oh also — there really is no “typical” Graves’ patient, we all choose different paths, for different reasons. It’s a nice thing that we have so many options for successful treatment, but it can be tough to decide between them when we’re ill. It’s nice that you’re feeling well now, so you can relax and take some time out to do all the research. You’re doing well now, and that may last for quite a while, but since the possibility exists for illness returning, it’d be a good idea to know all you can. Knowledge definitely helps in the decision process.

Long term ATDs are a valid treatment choice — some doctors may advise against it, but others are fully supportive, so it ends up being a choice you can make for yourself. Don’t let anyone bully you into something you don’t want to do.

[cynna]

#1170210

Oh everything about this disease is 6 of one, and half dozen of the other! 😮 Thanks so much for your replies!

[Bobbi]

#1170211

Just another factoid to consider: As we age, side effect issues with drugs increase. Our livers and kidneys become less efficient at processing out the toxic by-products of drug metabolization. I was in my 50s when I was diagnosed with Graves, so that reality entered into my evaluation of which treatment option to pursue, long term.

[MaryI]

#1170212

Hi Kimberly,
I also chose Methimazole as my treatment. What do you consider as low dose? I am doing well on 7.5 mg per day. Just curious, esp. as I am 57 and now a wondering about my aging liver & kidneys metabolizing the drug in the next years(as Bobbi had posted).
Mary

[Kimberly]

#1170213

Hi Maryl – The guidance doesn’t provide a specific range for the term “low dose”, so I would discuss this with your doctor.

In general, the liver and kidneys do become less efficient at metabolizing drugs as we age. However, I have not seen any specific studies related to aging and liver complications from methimazole.

The following article from UpToDate (the section editor is a gentleman who presented at our 2009 conference in Charlotte) notes that there is an increased incidence of agranulocytosis (severe reduction in white blood cell count) in “elderly” patients who are on high doses of methimazole. However, there isn’t a mention of adverse liver effects increasing with age, nor does it define “high dose”.

(Note on links: if you click directly on the following link, you will need to use your browser’s “back” button to return to the boards after viewing. As an alternative, you can right-click the link and open it in a new tab or new window).

http://www.uptodate.com/contents/patient-information-antithyroid-drugs

Take care!

[Author]

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