[bhdc71]

#1018190

Hello everyone,
I was wondering if anyone could provide any insight in regards to the results of RI treatment in men, more specifically any weight issues that may occur. (I’m a 24/m and was diagnosed in February of this year).

Some background : as a child I was fairly overweight and topped out at about 210 (i’m 5-8") when I was 16. From the time I was 16-17 years old I managed to lose about 30-40 pounds. For a few years I stayed in the 150-160 range and felt fairly healthy. Last winter I began to notice significant weight loss (down to 129lbs), termors, increased anxiety, sleeplessness and a severe decrease in strength and stamina (i was gassed by the time I made it up a single flight of stairs). My primary care physician suspected a thyroid issue and confirmed GD with blood work. With the exception of frequent bowel movements and eye issues all of the symptoms lined up. The first endo i went to see was very nice and helpful, but immediately recommended RI treatment. As I my main concern was being healthy again I didn’t second guess him. After reading up a little I began to grow a little concerned. in my mind it didn’t make alot of sense to treat hyperthyroidism by giving me hypothyroidism and treating the latter, instead of just treating the initial condition. And having been overweight throughout my developmental years, it made me extremely reluctant to pursue treatment that could possibly put me back in the position I worked so hard to get out of. After all, I was just recently starting to overcome all of the issues associated with being overweight (self esteem, confidence, etc.).

In August of this year I went to see another Endo, who agreed with me that we should atleast try to treat my condition with medication before we think about RI. Initially my heart rate was 130bpm resting and my blood pressure was 180/80). She gave PTU (around 700mg/day) along with propranolol. Luckily as of last week it seems i’ve responded tremendously to the treatment and my levels are in the normal range, to where I won’t have to take as high a dosage of meds now, and I weigh in the 155-160 range.

Now to my main issue/questions:
Am I right to be concerned about RI? Do the replacement hormones work as well and easily as they (proponents) make it seem? Should I be concerned that I’ll eventually stop responding to the current treatment?

Any insight would be greatly appreciated.

Thanks!

[Bobbi]

#1063164

REplacement hormone IS thyroid hormone (T4), and it works precisely like natural T4 in the body. Since Graves disease is an autoimmune disease, it is likely that whatever treatment option we pick, we will need to be on it forever. There may be periods of time (called remission) where we can do without meds, but the most likely scenario is to have to take the meds – whether antithyroid drugs, or replacement hormone — forever.

Whether you choose to do antithyroid meds over RAI, the decision should be based on the effectiveness of the drug treatment. There are some people whose bodies float into and out of hyperthyroidism while on the antithyroid meds. In other words, the med dose has to be continually changed and the person experiences frequent episodes of "being" hyperthyroid. This is not good. Any amount of time hyperthyroid causes bone lose and muscle loss, and puts stress on the heart. Typically, when we destroy the thyroid (either via RAI or surgery), we do not experience any frequent bouts of hyper again. That said, there are many people for whom the drugs control things very well. If that is your experience, and you are not experiencing any side effects to the drugs, there may be no good reason to switch at this point in time. Or, perhaps, ever.

I hope this information helps.

[snelsen]

#1063165

Hi, welcome to the boards. Just want to say that people choose different paths of treatment mostly for their own personal feelings or reasons. If you go to the search engine, type in the different treatments, you can read the thoughts of others on the board as they decided what they wanted to do. All choices are represented by people on this board. There is no absolutely right or wrong answer.
Shirley Nelsen, snelsen

[Kimberly]

#1063166

Hello and welcome to the boards! I just wanted to add a couple of comments…

1. If you do a search on this board for “weight”, you can see that many posters here share your concerns. I really wish doctors would pay more attention to weight issues, as it has an impact not only on self-esteem, but also on overall health. However, I don’t think it should factor in to your ultimate treatment decision. I have met patients who are on anti-thyroid drugs, patients who have had RAI, and patients who have had surgery – and *many* of us struggle with weight issues, no matter which treatment option we have selected.

2. You asked if the replacement process was as “easy” as doctors make it seem. I don’t know what you’ve been told, but quite frankly, many doctors tend to sugar-coat the process of finding the right dose of replacement hormone. When explaining the treatment options, my own doc said “after RAI, you’ll go hypo – and then you’ll just take one pill a day to correct that.” I had this vision of having RAI one day, being hypo the next day, and then being given a “hypO pill” to take every day. In reality, it takes varying amounts of time for the RAI to do its work in destroying the thyroid gland. Once you do go hypO, your doc will make his/her best estimate at what your initial dosage of replacement hormone should be, based on factors such as weight and age. Then you will have a follow up set of labs done in 4-6 weeks to determine if that is the correct dose for you. It *does* take several weeks before you know if that is the right dose, because it takes some time for thyroid hormone levels to build up in your body. If the next set of labs reveals that you are hypER or hypO, the doc will make an adjustment, and you will follow up in another few weeks. So it may take several iterations before you find the right dose that will keep your thyroid hormone levels in the normal range – and get you to feeling good again. Also, there are some specific guidelines regarding taking the replacement hormone on an empty stomach – and making sure that certain nutritional supplements are taken several hours apart from the replacement hormone. There are members on this board who have had great success with RAI…but I do wish that doctors would give patients better information as to what to expect during the first few months after treatment.

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