[DianneW]

#1073966

That is so individual that it’s difficult to predict, and would be different for surgery than for RAI.

Many people don’t ever take any time off work for RAI, depending on what the job is and how severe the hyperthyroidism is, and how well-controlled the levels are during the entire process. If your job is very physical or very stressful, you may need time off, whereas if you have a low-key, low-profile job in a back office with understanding employers, you might make it through without missing a day. You might be the boss or responsible for managing other employees, and not emotionally in a condition to handle those stresses without damaging your career. This is a case where ideally a good discussion with your doctor about your capacity to function would result in an assessment of whether time off from normal duties is required; and if so, an estimation of when normal duties may be resumed.

Typically the period of time necessary to restore thyroid levels to normal on a stable basis following RAI takes a minimum of 6 months, but more often 9 months to a year. During the early months especially, this process can be very uncomfortable (for some people more than others). Some people report feeling worse once they become hypothyroid than they ever felt when hyperthyroid, while others report that they were happy to become hypothyroid because it felt better to them than being hyperthyroid.

My guess is that if you choose RAI and needed time off work at all, you may or may not take a few days off for the RAI to avoid exposure to other people if you work closely with them, and it’s possible you might have a period of a couple of weeks or less (about a week after your RAI) when your damaged thyroid "dumped" excess hormone, making you more hyperthyroid for that time and increasing your symptoms. After that, you may or may not feel bad enough when you become hypothyroid to need time off work for a short time while thyroid replacement hormone kicked in. If so, it would probably only be for a few weeks.

If you choose surgery, my guess is that you might need about two weeks off work, but wait to see what people who have had the surgery actually say about that. I do know that the process of adjusting replacement hormone is faster for most people following surgery than it is following RAI, so in that regard it’s a lot more pleasant. The trade-off is that as with all surgeries, there are some risks. In the hands of a good surgeon, those risks are minimized.

But as for your question, how long do you plan? It’s impossible to say for sure, because you can’t see into the future. You’ll have more of an idea when you make your treatment choice. After that, it depends on your individual circumstances (your doctor might have some idea), and if you need more time you should take it. You said you have a high stress job and commute a long distance, and I think you should consider those factors in your decision. That might mean you need a lot more time off than some other people do. Other factors to consider are how much help you have at home, child care arrangements, whether you are risking your career by showing up in poor condition, and whether you’re risking your safety by driving in poor condition, and whether you’re able to get enough rest. There are probably others I haven’t mentioned. Be easy on yourself. Consider working shorter days or shorter weeks for awhile if that works.

Best wishes in all those decisions,

[amyl]

#1073967

Hi Dianne,
We’re starting to seriously consider RAI or surgery for my son. He’s been so nauseous for over a month now and he’s had enough. I’m now trying to figure out which would be best for my son. If he does RAI, does he have to miss some school time? He’s not going to school all that much anyway right now because he’s too sick. He wants to do whichever will give him the fastest results. From what you wrote, it sounds like the surgery might be quickest. I honestly don’t what to do at this point and welcome any advice.
Thanks so much!
Amy

[Ski]

#1073968

Hi Amy,

Your son would only need a day or two off school for the RAI ~ if that. If he could take it on a Friday morning, he’d be "okay" for school by Monday morning (though not "well" yet, certainly). Waiting for his levels to come all the way down, and then work them back up, may take some time. Still, he’d be feeling better each successive day, and he wouldn’t have to stay in the hospital for any length of time. With diligence, levels can be managed fairly well after RAI. With a large enough dose, you can usually say the thyroid will be GONE in six weeks, but it’s a little art, a little science, the dosing strategy. If you choose to go that way, I’d say you should have a pre-appointment with the radiologist who will administer the dose. My personal mistake was not having that appointment, just trusting that the doctor "knew best" and had consulted with my endocrinologist. NOT so.

At least with surgery you know it’s gone that day, but then you need a hospital stay, and probably at least a week or two out of school to recover.

It’s such a personal decision ~ you & he need to make it together. We can’t really say one is "better" than another. They both work, but they each come with caveats. Maybe make and discuss a pro/con list ~ that’s my sister’s favorite way to make decisions. ” title=”Very Happy” />

[DianneW]

#1073969

Hi Amy,

For most people surgery gives the most rapid results, but of course that has to be balanced against the risks inherent in surgery. Have you talked with his doctors about how soon it could be done in his case, or whether they think it’s indicated?

If you and he were more comfortable with RAI, the effects can usually be somewhat hastened by giving a larger dose. The results aren’t guaranteed because every thyroid seems to react in a unique way and radiologists (as much as they’ve tried) haven’t found a reliable formula for predicting a uniform response. A larger dose will result in fewer treatment failures, and destroy more thyroid tissue, leaving less of the thyroid to later cause problems with adjusting replacement hormone, which can be a problem for some patients for quite awhile following RAI.

What happens is that the thyroid tissue not immediately destroyed by RAI is still radiation-damaged, and while it continues to produce thyroid hormone (even though the patient may be hypothyroid and taking replacement hormone) it has a limited ability to reproduce itself, and a shortened life span. Add to this the effects of thyroid antibodies, especially TPO antibodies (that cause hypothyroidism), which many GD patients have, and this thyroid tissue continues to die out.

When it happens fairly rapidly, the patient may go through a really rough time of unstable thyroid levels that can last for a year, or longer, and be very uncomfortable. If it’s a slow process, the patient will more likely feel well, and the replacement adjustments will take place on a yearly basis.

If most of the thyroid can be destroyed initially, most of this adjustment phase can be avoided. The problem is, there are no guarantees that this will happen. The endo and radiologist can pick a dose of RAI with that in mind, and end up with a treatment failure completely, or with a slowly failing thyroid.

RAI hasn’t been given to teenagers or pediatric patients for too many years yet, because doctors used to worry that young people were more susceptible to the effects of radiation. Therefore, no really long-term studies have been done on this population to assess the safety. While all evidence so far indicates it’s safe in teens and children, know that the final results will include the outcomes of young people who are currently choosing RAI. Some doctors are convinced now that it’s safe, and a few others are more cautious and advise to wait for some long-term results.

With surgery, a fixed amount of thyroid (often pretty much the entire gland, though not all of it can ever be taken) is immediately gone. It takes some time for excess hormone already stored in the body to be used up, but when that process is completed (usually within a week), the hyperthyroidism is gone for good. By that time the endo has usually already started the patient on replacement hormone and it’s had a chance to start becoming effective, so there are ideally no huge drops or wild fluctuations. There may well be a few months of discomfort while exactly the right dose is found, and even when levels are normal it takes time to feel well again; but until stable normal levels are achieved, regaining good health won’t begin.

These are some issues I think you and your son would do well to discuss with his doctors, and perhaps that would help him make a decision. I hope this helps.

Best wishes,

[amyl]

#1073970

Thanks Ski and Dianne,
As always, your advice is very welcome! This is such a hard disease to deal with and it leaves me spinning. I keep going round and round about what to do. I am planning to talk to my son’s doctors to get their advice too but I feel strongly that I need to follow my gut on this. Unfortunately, my gut is confused too ” title=”Smile” />
I think what’s the hardest of all is that this has been going on so long that we just want it over with. I’m finding it hard to be patient and patience is so important with GD. I have hypothyroidism so I know it’s a long process to find the correct dose of meds and that’s ok for me because the side effects aren’t too bad. My son is the one struggling and I want to fix him now and that’s just not happening.
So…..enough complaining…. thanks for your advice and just for being there!! I’ll let you know how things go.
Amy ” title=”Smile” />

[DianneW]

#1073971

Yes, we need a Graves’ fairy with a magic wand to make it all go away. If I had one, I’d fix EVERYONE!! Those treatments all work, but they aren’t fast enough, are they?

I remember those rough times when I felt so awful and everyone was telling me to just be patient and I’d feel better. It seemed like better days would NEVER come, but they do—I promise!

It’s got to be worse when it’s your child and as you said, you’re watching him feel miserable. Take heart that no matter whether you and he choose surgery or RAI he WILL get better, and that’s what really counts!

[MonikaOH]

#1019774

Hi,
I am a workoholic, driving 130 miles a day to work place in a stressfull environment.
I have 8 mo old son and just bough a house so we need to plan for my short term disability leave.
How long doest it take to get back to functioning stage so I can go back to work???

[Author]

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