Antithyroid Treatment as Effective as RAI for Graves Relapse and better for TED

[Clutter]

Low-dose antithyroid drug therapy for Graves' disease relapse is as effective as radioiodine (RAI) treatment in preventing further relapse, with Graves' ophthalmopathy showing even greater improvement with the drug therapy, according to a new study published in the journal Thyroid.

"Our findings demonstrated that for patients who relapse from the conventional use of antithyroid drugs after 12 to 18 months and do not desire a definitive treatment with RAI or surgery, the use of a prolonged low methimazole [MMI] dose is a feasible option," lead author Danilo Villagelin, MD, of the School of Medicine at Pontifical University Catholic of Campinas, Campinas, Brazil, told Medscape Medical News.

While antithyroid drug therapy is well-established as a treatment option for hyperthyroidism due to Graves' disease, research shows remission rates can range from 30% to as high as 70%, prompting some doctors to recommend RAI treatment or thyroid surgery as more definitive resolutions.

The latter approaches have their own undesirable effects, however, including the need for lifetime thyroid-hormone replacement and increased risk of hypothyroidism.

cont/d...

medscape.com/viewarticle/85...

[shaws]

Clutter that's good news for many people some of whom are forced into RAI etc.

[Clutter in reply to shaws]

Shaws, and hopefully for people like my sister who was badly advised to have RAI to prevent TED worsening.

[shaws in reply to Clutter]

And it's the patients who have to live with the consequences.

[bantam12]

I had many relapse over the 30 odd years I had Graves, anti thyroid meds were not working, I had to have surgery in my teens because it was badly affecting my heart, then RAI in my 40s because I was sick of messing around with the constant dose changes. I don't regret either for one second.

[Clutter in reply to bantam12]

Bantam12, RAI was the right decision for you then. My sister's only regret is the RAI she was told would improve her eyes has made it worse. Thyroidectomy would have been a better option with respect to TED.

[bantam12 in reply to Clutter]

I possibly had very mild Ted before the RAI so was given several months of steroids to prevent any problems, thankfully it worked.

One of my sisters had severe ted, she was hypo (never had graves)

and her eyes although much better never fully recovered.

[Clutter in reply to bantam12]

Bantam, I don't know whether sis had steroids, I assume she would have, but cosmetically eyes are worse and she needs lubricating drops.

She's so determined not to feel hyper she keeps herself a little undermedicated with TSH >2.0.

[alangardner in reply to Clutter]

hi clutter , my lady has found that when she is out/visiting/shopping or wherever it is too difficult to use drops , but , she now uses an advertised brand of spray [ p.m. me if you want ] she just sprays it onto the outside of her eyelids.....blinks ---- and this seems to be a short term fix for the ' eye-dryness/ soreness ' until she can use the drops ....... maybe it could be of help ......alan xx

[Clutter in reply to alangardner]

Alan, the dryness isn't so bad that she needs rehydrating constantly. Thanks anyway.

[alangardner in reply to Clutter]

but , it does seem to help when not at home though

[ling in reply to bantam12]

Hi bantam, how did Graves affect your heart?

Thank you

[bantam12 in reply to ling]

It was a long time ago so I can't really remember but I know I had a very fast heartrate and the docs were concerned, I was on beta blockers for quite a while.

[ling in reply to bantam12]

Thank you bantam. Sorry to be a pest. By any chance, do u remember what surgery u had for the heart?

Thank you

[Fruitandnutcase]

Thanks for that Clutter - very interesting

[Suin]

I had RAI 21 year ago, I was lead to believe it would be the answer, it isn't! 😐

[Clutter in reply to Suin]

Sorry to hear that, Suin.

[Suin in reply to Clutter]

Aw that's life, live and learn.

Great to be so much better informed, with WWW, but

more so, yourselves on healthunlocked ✋🏼💞

[mothsballs]

like bantam12 I also had to have RAI as after many years on medication my thyroid medication was no longer working for my Graves disease. Rai was strongly recommended because of the strain on my heart and due to being post menopausal the additional risk of brittle bones.

[Clutter in reply to mothsballs]

Mothsballs, the article may be of more interest to patients who felt well on anti-thyroid drugs or B&R and are pushed towards RAI when remission fails.

[ling in reply to mothsballs]

Hi mothballs, how are things after the RAI?

Thank you

[mothsballs in reply to ling]

Hello ling,

I am still struggling since having RAI. I am very dose sensitive & never feel optimal health, the dose is forever been adjusted. I stick to the same brands of medication and have since gone gluten free, which all help a little, but i feel I have just swapped one set of conditions for another. I still get breathlessness and racing heart occasionally but nothing like when I was overactive. Instead of needing the toilet urgently several times a day, I find i'm constipated. My food bill has come down though as i am not constantly eating and hungry that has made a huge difference. So at least I can get on with life without worrying at work if I will go faint & get the shakes. I was getting this and racing heart whilst on quite a high dose of anti thyroid medication, which is why i reluctantly had the RAI. It was clear after years on it , having a couple of breaks and also B & R the medication was not as effective any more, maybe i developed some kind of immunity.

I am still very thin, but not as bad as when I was over active so some clothes do now fit. After nearly 30 years of being over I suppose 3 years on being slightly under i am still tweaking things to work out what works best for me.

[ling in reply to mothsballs]

mothsballs, thank you very much for your reply.

Yes I know what u mean. After being hyper for 30 years, it's gonna take some time for the body to adjust to another state. I'm glad though that the nastiest symptoms are eliminated.

Any idea what caused your hyperthyroid? Was it Graves?

Did u have your heart checked during the 30 years?