Thyroid UK
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Optimal treatment required?????

Hello, this is my first post so be gentle with me! I have a couple of questions. I was diagnosed with graves approx 2.5 yrs ago provided the meds to try and stabilise (carb and prop) however last consultant visit advised rai would be the next option as readings were tsh0.01 t4 51 and t3 18' basically i have another appointment on 12 June and i think the rai would be agreed. Ive been taking 50mg carb for the last 3 weeks to reduce, I know bodies are very individual but do any of you have an idea how long it will take to go hypo, also if i ask is the consultant likely to give me a combination t4 t3 instead of t4 alone. Or do i wait to see if the t4 works!!! I,m a little apprehensive so say the least because I'm expecting to be much worse than i already am!

4 Replies

I don't have Graves and you will get responses from those that have.

I thought, anyway, that I would post the following for your information - it is from an article by Dr Toft, ex President of the British Thyroid Association.

5 Patients with hyperthyroidism often ask for advice on drug treatment versus radioiodine therapy. Can you summarise the pros and cons of each?

The three treatments for hyperthyroidism of Graves’ disease – antithyroid drugs, iodine-131 and surgery – are effective but none is perfect.

Iodine-131 will almost certainly cause hypothyroidism, usually within the first year of treatment, as will surgery, given the move towards total rather than subtotal thyroidectomy.

There is no consensus among endocrinologists about the correct dose of thyroid hormone replacement so patients may prefer to opt for long-term treatment with carbimazole. Standard practice is that carbimazole is given for 18 months in those destined to have just one episode of hyperthyroidism lasting a few months.

But there’s no reason why carbimazole shouldn’t be used for many years in those who do relapse. Any adverse effects such as urticarial rash or agranulocytosis will have occurred within a few weeks of starting the first course.

Iodine-131 treatment for toxic multinodular goitre is the most appropriate choice as hypothyroidism is uncommon. Surgery would be reserved for those with very large goitres and mediastinal compression.

Once hyperthyroidism has developed in a patient with a multinodular goitre, it will not remit and any antithyroid therapy would have to be lifelong.


I've got Graves and have been on Carbimazole for five months with levo added in three months ago, can't take prop because of my asthma. The hospital I go to uses 'block and replace' which is why i am on carb and levo. I was told at my first hospital visit that I would be on this regime for two years. Obviously everyone is different but as Dr Toft says 'there is no reason that you can't continue using Carbimazole for many years' that is what I would hope to do rather than RAI or a thyroidectomy should I relapse at the end of my treatment time. I'm sure someone who knows more will be able to tell you about T3 etc.

Good luck, Liz


Thanks both Liz and Shaws both your replies are really useful, im not sure why this was not a consideration? The consultant left me with no doubt that rai was the only option, i do have a moderate goitre and had been reacting very well to the carb however when the doseage was reduced down to 5 m i obviously relapsed. I.ll have this discussion with him in June.


There is a protocol in using selenium for Graves I think.


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