Whats happens on 1st visit to endrocologist with a gotire and hyperthyroidism. Grateful for reply thanks carroll

[carroll998]

[shaws Administrator]

I am not sure as I have hypothyroidism. This is an extract from an article and it may be helpful to you:-

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.4

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.

[Fruitandnutcase]

I would say all of the above is very relevant. Although I am hyper I don't have a goitre but first visit was a bit of a let down, I didn't see my endo but a senior houseman, I was told to take a urine sample which wasn't needed. I had my height and weight measured, my BP taken sitting and standing, that was all done quite quickly then it was back to wait my turn.

I had taken questions I wanted to ask - I write them down to look at and work my way through. I had read so much on here and in books that I wasn't told anything I didn't know already. The guy had a quick feel and said I didn't have a goitre - I don't, he moved his finger for me to follow and said my eyes ere fine - well I don't have 'lid lag' but they are incredibly dry, I get double vision and at times they feel awful, I told him but that doesn't seem to count as they don't bulge.

It was very disappointing really. I had been taking Carbimazole for three months, I had become under active - he told me to stop taking the Carbimazole 'for a few Days!!!!!' but to start on the levo he prescribed at once.

Make sure to ask what your test results are along with the lab ranges, that way you will be able to see the levels at which you feel well.

I would say just don't expect much then you won't feel disappointed. I came away feeling very down even though there was probably nothing wrong with the guy. Good luck.

[carroll998 in reply to Fruitandnutcase]

Hi thank you for your replies. I have my blood test results and ranges and my tsh is under 0 1 my t3 and t4 have dropped within normal range and r heading towards the lower part of the range since I have been taking 40mg of carmibazole over the last 4 weeks. Over the the last 6 months my body and my my mind has been through quite alot really 6 months ago I had sepsis then I had a parathyroidoctomy which trighered my thyroid to go overactive which triggered me t go into atrial fibrillation for which I spent 1 week in ccu they couldnt use thr cardioversion because my thyroid was overactive. They put me on 15mg of bisporol which made my heart go t 40bpm I am now on 1.25mg. I have been through so much I dont know how I feel really. Sorry I have gone on but I feel much better for writing about it. I wont go into all the mistakes which were made my supposed professionals on the way. Take care God bless carroll

[Fruitandnutcase in reply to carroll998]

Gosh you have had an awful time haven't you. Glad you feel better having written things down, I found this site such a help, there are so many people who can offer good advice and understanding. You just need to watch that you don't become under active, that isn't nice but in a different way to being hyper.

I felt very good when my TSH was under 1 and my T4 was near the top of its range. Hopefully if you are having your bloods done every month that won't happen. Are you going to be given thyroxine soon?

[carroll998 in reply to Fruitandnutcase]

I see my endro for the 1st time on tues hopefully he or she will either suggest I cut down on my carmibazole or add thyroxine I so scared they wont syggest either and yet again I will have to say something. I get so fed up of having ni trust in doctors and having to intervene myself. You take care

[Fruitandnutcase in reply to carroll998]

If you are taking that much Carbimazole I would imagine they will have to either reduce it gradually or keep it the same and add levo. I had a month on 20mcg then two on 40 before I ended up very hypo then I was given 50 mcg levo that was increased gradually to 100mcg . Good luck on Tuesday, let us know what happens.

[carroll998 in reply to Fruitandnutcase]

Will do thank you

[carroll998 in reply to Fruitandnutcase]

Hi well saw endr today was weighed but didnt do my bp or pulse which I was quite surprised at. At the qmc hospital were I went the just reduce the carmibazole only apparently if they your are taking 60mg of carmibazole they will add thyroxine but only at that level anyway hadca nice chat and he reduced my carmibazole to 10mg per day instead of 40mg and I have a blood test in 6 weeks time and go back to see him in 4 months. I would prefer blood tests every 2 weeks but guess u cant have everthing. All in all a good experience. Take care carroll

[Fruitandnutcase in reply to carroll998]

Sounds good doesn't it. 6 weeks seems to be about the time they retest. When I was needing an increase in my levo I could always tell at about six weeks. Don't know what happens when they are going it by titration but you will maybe able to tell too - glad you had a good visit

[Busdy123]

Hi there

Mine was pretty much the same. Just a lot of her talking and me listening everything she said I already knew from my own research. She did no further tests and just discussed treatment options and I chose carbimazole. She said okay great you need a blood test once a month and my nurse will call with any medication changes needed. Ill see you again in 6 months.

It was quite disappointing.

[Fruitandnutcase in reply to Busdy123]

I wonder if that is because we had researched our condition before we got there. I didn't really get a choice I was just told all the methods of treating an overactive thyroid then told the hospital used B&R - that suited me though although now I wonder if ever decreasing amounts of Carbimazole might have been better, think that is probably more work for the hospital though. How did your second visit go or have you not been back since? On my second visit I saw the endo instead of a sidekick and that was an awful lot better, I came out feeling much more positive - nothing really changed but the person I saw had a much better 'bedside manner'

[curlijo]

Hello,

I was diagnosed with Graves disease about 10 years ago.

Firstly I went to a very good doctor who recognised my elevated heart rate as an indicator of a thyroid problem. I had a test and she diagnosed a thyroid problem and referred me to an endocrinologist. My endocrinologist took lots of blood tests and put me on 5mg of carbimazole. I was expected to visit her every 6 weeks after having done my blood tests a few days before. Once my thyroid function reached a normal level I was tested for Graves disease and was told that I did have the antibody for graves. I was injected with a low dose of radiation and had my thyroid 'x-rayed' where they found a very small goitre. I continued with carbizamole at 5mg for 6 months and then swung into hypo, I felt so bad that I took myself off of my medication long before my next appointment and began to feel better. The endocrinologist told me I had gone into remission and that my recovery was exceptional, which was puzzling to her. She advised that I test my thyroid every 6 months at my GPs and any signs or symptoms to request a referral to her. I was in remission for 10 years and didn't need any medication. Now I feel I have swung into hypo and am currently overseas. I can just walk into the hospital and order and pay for any test so I am learning about tests and what to request as I haven't got the guidance of an endocrinologist here (there's a 4 month waiting list). So hopefully I will be able to be referred to an endocrinologist asap when I get back in April.

The thyroid is a very complex problem and dealing direct with a specialist, communicating my symptoms to her was the best course of action for me. I believe that GPs don't fully understand the problems and complexities of the thyroid and you are in better hands with an endocrinologist.

Good luck, with the right care and medications you will start feeling better soon... and it was such a relief. A good endocrinologist will help you find the right balance and treatments.