[KennethB]

#1017841

Hello! I was diagnosed with Graves in Feb 2010 after suffering from double-vision, constant sweating and finally a couple of scares with rapid heartbeats. I went on Methimazole and was doing well, weened off in December 2010. Then my Feb 2011 blood tests showed that the Graves was back. At my next endo visit, I was told to do some research and come back in August with a decision of RAI or surgery. My doctor is great, but really wanted him to tell me which one he thought I should do. I have read many posts on here and there is some great advice.

I have two questions that I was hoping someone could respond to:
1. For males suffering from Graves, has RAI or surgery been anymore succesful than the other? From my research I have found that GD is primarily something that females suffer from, only about 10% are males.
2. I’m having some guilt about choosing RAI because I teach in an elementary school. So I have 27 kids in my room for most of the day, and then I’m around 300 students during morning, lunch and bus line up duty.
3. Because one of my symptoms is occasional double vision, does one treatment plan fit better than the other?

Thanks in advance for any guidance you can provide!

[Bobbi]

#1061263

Hi, KennethB, and welcome to our Board.

I know of no studies that have demonstrated any differences in effectiveness of our treatment options based on sex differences. Yes, it is true that a much larger percentage of women develop autoimmune problems than men, but the treatments themselves have to do with hyperthyroidism, and not the underlying autoimmune "mistake."

RAI was shown in one, single study about ten years ago — and, thus, I’m not sure whether its results are still considered real or not — to stimulate an immune response that, in approximately 16% of the population given the RAI, provoked a "temporary" increase in eye disease symptoms. It does not cause the eye disease, but it may, temporarily, worsen the symptoms of the eye disease. The same study showed that a concurrent course of prednisone, with the RAI, prevented the temporary worsening of the eye disease symptoms. What this suggests is that if your doctor thinks that RAI is preferable to surgery, for whatever reason, you should discuss the prednisone option with him/her, given your intermittent double vision.

Whether or not RAI is appropriate for an elementary school teacher? Do you have vacation of any type soon? It is summer, and many teachers have a hiatus. That would probably be preferable. We are cautioned to remain a few feet away from small animals and children for about a week after our RAI. (This is typical, but is based on the dose of RAI needed to achieve ablation so it could be longer, or shorter. You’d need to speak with your doctors and the nuclear doctor administering the dose.)

Wishing you good luck with your decision,

[Kimberly]

#1061264

The research has actually been somewhat conflicting on the “worsening” vs. “new development” of TED with RAI. In one of the earliest studies (Bartalena et. al., 1998), the risk was more weighted toward *worsening* of TED. In a more recent study (Traisk et al., 2009), the risk was much more weighted to the *new development* of TED.

For reference, here were the percentages of patients experiencing complications (either worsening *or* development) with TED following the different treatment options:

Bartlena 1998:

RAI: 15%
Anti-Thyroid Drugs: 4%
RAI + Steroids: 0%

Traisk 2009:

RAI: 38.7%
Anti-Thyroid Drugs: 21.3%

Another study (Perros et. al from 2005) concluded that RAI was not a risk factor for patients with “minimally active” eye disease as long as hypothyroidism was prevented with early administration of T4.

The latest guidance from the American Thyroid Association and the American Association of Clinical Endocrinologists notes that “…Methimazole or thyroidectomy are…the preferred choice of therapy in patients with active and moderate-to-severe or sight-threatening GO.” The guidance also notes that a course of steroids may be administered in conjunction with RAI to reduce the risk of eye complications.

Eye complications are not a *given* with RAI. With the two studies above, 85% of the non-steroid 1998 RAI group and 60+% of the 2009 RAI group did NOT have eye complications. However, the increased risk is certainly something to take into consideration when making a final treatment decision. Also, patients who undergo RAI may also wish to talk to their doctors about the risks vs. benefits of a course of gluticosteroids.

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