Today's hospital visit

Today I am going to see the endocrinologist/nuclear dr regarding RAI any questions that i need to ask? I have started a list but I'd welcome some advise. Thanks in advance

[shaws Administrator]

I will give you a quote by Dr Toft who was President of the British Thyroid Association. Members who have had RAI will respond or maybe have done if you've posted before.

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.

[Hidden in reply to shaws]

I have reacted very badly to carbizamole & ptu so can't do long term drug therapy

[shaws Administrator in reply to Hidden]

I am sorry about that so you need RAI and wish you well. I also sincerely hope that if you don't do well on levo (many are fine) that they will allow you an alternative medication.