Hyperactive thyroid/treatment - worth a 2nd opinion?

[ERD50]

My wife had a variety of vague symptoms (I'll skip the details) - similar to a flu that had gone through our family, but lasted longer. Got her to a doctor today. Everything points to hyperactive thyroid, but we won't get the T3/T4 test results until tomorrow.

Doctor said, if tests confirm it, it probably means either blasting the thyroid with radioactive iodine, or surgically removing one or more of the parathyroid glands. So, I've read up on these today, and both treatments seem relatively minor. Of course, if they de-activate too much of the thyroid, she will be on the hormone replacements for life. Not really a big deal, I guess.

Everything seems to add up, so my question is - is it worth seeking a second opinion on this, or is it just a waste of money and will just confirm what the first doc said?

On one hand, I feel pretty comfortable with the doc's assessment. It seems like a fairly straightforward cause/effect. OTOH, it is a permanent thing, and there are always risks, even with routine treatments.

So, go for 2nd opinion, or just go with the first diagnosis?

-ERD50

 

[Rich_by_the_Bay]

Well, first of all you don't remove parapthyroids for hyperthyroidism though they do sometimes get removed s bystanders when the thyroid gland itself is partially removed,

There are different causes for hyperthyroidism, and that needs to be assessed - usually with an I123 uptake and scan.

If she has Graves' disease and not a hormone secreting tumor then I131 is an excellent treatment. Virtually no risk (unless she's pregnant), no pain, very effective. As you say, often ends up that you take thyroid supplements at the end of the course.

As to 2nd opinion, a good internist who sees this regularly and communicates clearly generally would be a suitable person to handle this. An endocrinologist would be who I'd see next if you want another input.

All the best to her. Since the blood tests are not back, I'm guessing she doesn't have hyperthyroidism from your very brief summary.

 

[ERD50]

Thanks Rich. Some of that info was a miscue between my wife and myself. Blood test and T3/T4 test results, and then the iodine scan would be done prior to any decision regarding treatment.

We will know more after we get these results, it may well be that the doctor's next step was to have us see an internist or
endocrinologist based on these reports - maybe he was just taking it one step at a time. I'm just trying to educate myself a bit overall.

I was a bit surprised to find that this Iodine-131, (Radioiodine, Radioisotope Therapy) treatment has been done for 50 years, and has such a low risk. Funny how people get so scared by the term 'radioactive'.

Thanks, - ERD50

 

[spideyrdpd]

Funny how people get so scared by the term 'radioactive'

Yeah after all you get used to the glowing after awhile and it cuts down on the light bill.

If its mild wouldnt they just give the Anti-thyroid medications. PTU or methimazole ?

 

[Rich_by_the_Bay]

I was a bit surprised to find that this Iodine-131, (Radioiodine, Radioisotope Therapy) treatment has been done for 50 years, and has such a low risk. Funny how people get so scared by the term 'radioactive'.

Yes, it's an effective and safe treatment, mostly because the thyroid is just about the only place in the body that concentrates iodine so all the other organs are basically uneffected. There has never even been a hint of long term side effects.

Antitthyroid medications (such as propylthiouracil or PTU) are commonly given, too, either alone or in preparation for radioactive iodine. It's not a question of whether it is mild or not, but depends on a number of individual features. My personal feeling is that RAI is underused. PTU has some serious side-effects for some patients, often needs to be taken for 1-2 years, and needs fairly close physician follow-up. Every time I review this with patients I say to myself, why would anyone rationally NOT take RAI? It's a one or two day painless, riskless treatment, almost always effective, with the only downside being you take thyroid replacement tables once a day. But you are right, some have an irrational fear of RAI.

Anyway, good luck to her. Still a chance it's not Graves' til those results come back, so here's hoping it's a false alarm.

 

[maddythebeagle]

ERD50: where are you located? I could point you to my Endo. at the Mayo Clinic if you are in the upper midwest....Finding a good one is a pain in the ass...

 

[ERD50]

ERD50: where are you located? I could point you to my Endo. at the Mayo Clinic if you are in the upper midwest....Finding a good one is a pain in the ass...

Northern IL. So, mayo is not out of the question if it is needed, but this may end up being pretty routine. We'll learn a lot more on our next visit with the doctor, I'm sure. I realize now, without having the tests back, he would have needed to explain every possible path, and that would probably be info overload for us, and a waste of time for him.

But, yes, PM me with the contact info please. Then I'll have it if needed. Thanks.

I thought the path to finding a good proctologist was a PITA (sorry, couldn't resist)....

-ERD50

 

[cpolashenski]

It's not the term "radioactive" that scares me but the fact that I will missing a part of my body. I have friends on synthetic hormones that never feel well; the dosage needs adjusted constantly. I was diagnosed with Graves 5 years ago.

 

[ERD50]

It's not the term "radioactive" that scares me but the fact that I will missing a part of my body. I have friends on synthetic hormones that never feel well; the dosage needs adjusted constantly. I was diagnosed with Graves 5 years ago.

Certainly we would prefer to keep all our organs, and have them in good working order. It *is* a little scary to learn we may need to do without, and rely on substitute hormones. I suppose a properly functioning thyroid has some feedback mechanisms to keep those hormones regulated better than a daily dose from a pill could do.

But, if an organ is misbehaving, and needs to be deactivated - this sure sounds like a great way to do the job. If it were me, I sure would prefer an injection with the radiation targeted right to where it needs to go, than to be exposed to the risks of a surgeon's knife, the collateral damage, risk of infection and the whole healing process.

BTW, here's some interesting trivia about the synthetic hormone from wiki ( http://en.wikipedia.org/wiki/Levothyroxine ):

Synthroid is the most prescribed brand of T4 in USA. Synthroid was marketed in 1955,[1] but was not FDA approved at that time as it was considered "generally regarded safe". In the 1990s, in response to various complaints[citation needed], all levothyroxine preparations were required to undergo the formal FDA approval process. Synthroid was approved by the FDA on 2002-07-24.[2]

-ERD50

 

[cpolashenski]

I agree surgery seems riskier. I have no plans to do that either. My thyroid is fine; it is the immune system that goes haywire in Graves but that cannot be fixed. It's completely irrational, but I can't part with my thyroid. I take Tapazole on and off at a very low dose; seems to work great.

 

[JB]

18 months ago I was sick for 4-6 weeks with unexplained fever, night sweats, and flu like symptions. The internist said I had a sinus infection and put me on antibiotics. No change. The next visit she noticed my elevated heart rate and bood pressure. I had lost 15 lbs. They scheduled a thyroid test and sent me to the endocrinologist. The uptake test showed -0- uptake. (The scan didn't work because uptake was 0. I was frustrated that they even did the scan when they should have realized it wouldn't work). Low uptake in addition to a high sed rate confirmed sub-acute DeQuervain's thyroiditis. This relatively rare condition usually follows a viral infection and causes the thyroid to dump all it's hormone then shut down for awhile. Luckily normal function usually returns within a few months.

If the TH and TSH test indicate hyperactive thyroid, don't skip the uptake test.

 

[Achiever51]

More than 25 years ago I was diagnosed as being hypothyroid -- low thyroid function -- and for nearly that long I took one Synthryoid pill a day to replace the hormone that the thyroid wasn't producing. No big deal. My doc (an endocrinologist) periodically checked thyroid function and the Synthryoid kept me in a normal range. Never developed a goiter or any kind of external swelling.

But, in late 2004, I noticed that my voice sounded lower in pitch and I was getting hoarse frequently. This time, the endo ordered a thyroid biopsy (a very unpleasant procedure!) along with an ultrasound and the regular tests -- uptake, etc. Discovered that the left lobe of the thyroid was rapidly growing -- soon to be 2x normal size -- and was starting to wind around left vocal chord. Right lobe was also growing -- albeit slower -- but was starting to press on windpipe.

Ended up having complete thyroidectomy in July 05. Only pre-op worry was if the parathyroid glands were compromised -- if so, would mean major calcium replacement therapy for life (something like 20 to 30 pills a DAY, I was told.) Fortunately, parathyroids were not involved.

Had the world's worst sore throat for about a week -- now I'm back to taking my one Synthroid pill a day. Voice returned -- no other aftereffects. Even the scar is barely noticeable.

Good luck