[Ski]

#1071980

This is probably the single most common question we get, so you can get a LOT of information from a search, if you like.

The bottom line is that a lot of weight gain is not a given, by any means. Taking good care of yourself, watching what you eat, and exercising when you are allowed to, is all important. Knowing it’s a possibility is extremely valuable.

However, I must make a comment about the language you use ~ "I have been told that RAI is the best treatment for me." There are many doctors who have that opinion. There are many patients who would disagree. There are three potential treatments for Graves’ Disease: First, ATDs (anti-thyroid drugs), which you must take for a period of up to two years in order to see if they successfully put you in remission of the disease ~ they WORK for that two years, but they have the potential to put you into remission, meaning that you can have normal thyroid hormone levels for a period of time WITHOUT taking them, after you’ve taken them for two years; second, RAI; third, surgery. The choice, barring any obvious restrictions against any of them due to your medical history, is YOURS to make. It can be difficult to figure out, while you’re hyperthyroid, which is why our typical recommendation is to try ATDs first. Get your thyroid hormone levels down, get your thinking capacity back, and do some research to decide what YOU prefer. The doctor’s preference is fine to know, it’s good to have a really in-depth discussion about the reasons behind the doctor’s preference, but if, after you’ve heard everything the doctor has to say, you still feel as if you’d prefer a different treatment, that is for you to decide. The only thing you simply cannot decide is to have NO treatment, because hyperthyroidism is very dangerous, and needs to be corrected as soon as possible.

Now, back to the weight issue ~ ALL of us have the potential for weight gain, and here’s why. When we are hyperthyroid, we suffer loss of muscle mass. This isn’t just weight loss, it’s BAD weight loss, it removes tissue that helped us metabolize calories, even at rest. That means our balance is off afterward ~ eating the same amount and type of foods we ate before will produce weight gain, until that muscle mass returns AND we strengthen it. So at first, the weight gain (after we return to normal thyroid hormone levels) is a GOOD THING. We need that muscle mass. But we must strengthen it, or again, we do not have the calorie-burning element in place. We are advised against exercise while we are hyperthyroid (partially because it accelerates loss of muscle mass, but also because our heart rhythms can be irregular), so that makes it difficult and sometimes brings a little weight gain as well. Make sure you get clear instructions on what type of exercise is okay for you right now, and at each step along the way.

Just be careful, and realize that while you are undergoing treatment, you MAY have to go shopping at Goodwill for clothes that feel big enough for you. Buy them bigger than you need, so you aren’t fighting against a waistband all the time (nothing can depress a person quicker), and buy them at Goodwill so you don’t CARE that you are having to buy bigger clothes. Another reason for buying them bigger is so you have freedom of movement for the times you might be feeling good and wanting to exercise a little bit. Once your levels are normalized, you’ll be able to tackle the weight issue and win. ” title=”Very Happy” />

[marilyn]

#1019490

Hi All,

I have been newly diagnosed with GD. I have been told that the Radioactive Iodine treatment is the best for me, but i have heard stories of people gaining tremendous amounts of weight.
Is this true? I am almost more scarred about that than anything else. I do not want to blow up and deal with that. Please give me some insight.

[DianneW]

#1071981

Another comment on weight gain following RAI: A PubMed search will show that there have been many studies done on the relationship of weight gain to treatment for Graves’ Disease, and the results of study after study are that patients who have become hypothyroid following their treatment for GD and are on replacement hormone gain significant amounts of weight compared to people of the same age who still have functioning thyroid glands. So while excess weight gain isn’t completely inevitable, it’s likely.

I have been successful at taking off the 30+ pounds I gained following RAI, but was difficult, and isn’t easy to maintain. To be successful I have to skip meals entirely, NEVER snack except on fruits and veggies, and seldom eat goodies. This isn’t the way it was for me when I had a thyroid, though I have always had to be somewhat careful.

We have three treatment options: Antithyroid drugs, radioactive iodine, and thyroidectomy. Antithyroid drugs give you a chance of having a remission from hyperthyroidism. The usual protocol is to take them for 12-18 months (by then, most patients are on a very low dose) and then gradually stop. Approximately half of patients will be in remission at that point. For about 20% of cases (depending on the source of statistics) this remission is permanent, although some of these eventually become hypothyroid anyway.

When considering their options some patients want to do everything possible to be in this minority who have a permanent remission and will opt for antithyroid drug treatment. Even if a patient doesn’t have a remission or has a relapse following remission, it’s possible to take antithyroid drugs long-term, so theoretically any patient who doesn’t have a problem taking antithyroid drugs and can control hyperthyroidism on a small dose could use this treatment indefinitely, if a doctor would agree to provide it. Some doctors are worried about the risk of side effects over time, but a recent (2006) study in the European Journal of Endocrinology compared the cost and safety of long-term (10-year) methimazole treatment to the cost and safety of radioactive iodine treatment and found no significant difference. Still, there are a few patients who can’t tolerate antithyroid drugs, and when side effects do occur they can be serious, so that’s a consideration when making a treatment choice. Also, not everyone is motivated to do the monitoring of blood work involved, which can be more frequent initially than with the other treatments. For long-term treatment it might not be, though.

Radioactive iodine may be the safest treatment choice, but the goal is to make patients hypothyroid, so replacement hormone for life is to be expected. Most people do well, but some have a difficult period for six months to a year while thyroid levels are fluctuating, and some don’t ever feel quite right on thyroid replacement hormone.

Surgery to remove most of the thyroid is usually the fastest way to eliminate hyperthyroidism and restore normal thyroid levels. The disadvantages are that surgery is more expensive and that there’s a small risk of damage to the nerve to the vocal cords (causing hoarseness) or to the parathyroid glands, which results in patients needing to take calcium the rest of their lives. These complications are rare with experienced surgeons.

Most people can choose among the three treatment options, though many doctors recommend RAI for their patients simply because of the safety and ease of administration. Those factors may not be the only issues patients care about, however; so it should be a personal decision that the patient makes, not the doctor.

Some doctors recommend that their patients take antithyroid drugs initially, both to try for a remission and so that if that fails, the patient has a chance to consider the other options while thyroid levels are normal and brain and emotional function is better. It’s difficult to make sound decisions under pressure when one is really ill. I think this is a really good plan.

I know when you’re first diagnosed it’s scary to decide what to do. You don’t have to decide on anything right now that’s permanent if you want to take antithyroid drugs for now and see how that goes. Ask your doctor if he will support you in that plan for the time being, if that’s what you want to do, at least while you have a chance to be sure about doing the radioactive iodine.

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