[scanders]

#1060458

Hi,
I’ve read a few posts here from others that based on age, gender, severity of Graves or starting labs, etc, they weren’t good candidates for remission using ATDs. I’ve tried to find the articles that talk about these “predictors”, but have been unable to do so. I’m having labs and seeing endo again next week, and if things haven’t stabilized, I have a feeling she’ll want to talk, again, about TT. (No RAI because of TED.) So I’m just wondering if there are things I should be considering, such as what are the odds of remission for me? Or will I not reach remission, but will I be able to at least manage the Graves with ATDs? Or is TT a better, quicker option? Time plays some role, as the eye doctor said TT will further delay intervention for my eyes. But I’m starting to think my ATD roller coaster is also delaying the intervention. (Possibly decompression, for sure muscle surgery. I’m getting tired and impatient. I want single vision.) So, as usual, I’m just looking for more data to help with decisions.

Thanks,

Christy

[Kimberly]

#1182751

Hello – The ATA/AACE guidance on the treatment of hyperthyroidism (which you can find in the “Treatment Options” thread in the announcements section of the forum) notes a lower remission rate for men, smokers, and patients with large goiters, and the *best* rates for patients with small goiters, negative TRAb, and mild disease. The remission rates for this group was placed at 50%. One study from 1997 placed remission results for the very “best” profiles as high as 80%, although this study was fairly small to start with, and did not identify how many patients were in this even smaller subset.

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

http://www.ncbi.nlm.nih.gov/pubmed/9226205

This was another study that found the “best” profile for remission was a patient with female gender, non-smoking status, absence of orbitopathy and occurence of hypothyroidism during therapy. (Not sure what they mean by hypothyroid; the TSH levels in the article don’t look like they are associated with hypothyroidism).

http://www.endocrine-abstracts.org/ea/0029/ea0029p1576.htm

And another study that found lower remission rates for current smokers and patients with large goiter size:

http://www.thyroid.org/wp-content/uploads/publications/ctfp/volume7/issue5/ct_public_v75_3.pdf

But all of this does not mean that someone with the very worst profile – male, large goiter, high T3/T4, high antibodies, eye disease, smoker – can never go into remission. It just means that the chances are less than someone with a more favorable profile.

Not sure what the doc meant about TT delaying surgery for your eyes – maybe he/she can clarify that for you. Obviously, there’s a recovery period after the surgery and thyroid levels need to be stable, but I can’t imagine this would cause a longer delay than the other treatment options.

Hope this helps!

[scanders]

#1182752

Thanks Kimberly! That helps a lot! Admittedly this would be a lot easier with a crystal ball. It doesn’t seem that there’s really any hard and fast rules about who reaches remission as far as demographics, so it seems as if I have as good a chance as anyone. After all, research shows smokers have a higher incidence of TED, but I’ve never smoked a puff and still got TED.

I’ll ask the eye doc to please clarify why he said TT would delay intervention vs ATD titration. I’m curious. It seems to me either one still involves a fair amount of waiting. I don’t see him until the end of the month. And I think the endo is just trying to have me think about the other option “just in case…” That, and as she said, it’s a lot easier to dose replacement hormone than ATDs. I have no idea how I’m feeling right now–maybe I really am moving to normal or optimal–I can’t remember how that would feel. I think the saying is “symptoms are confusing, but labs don’t lie”, so I’ll see how things look next week.

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