Graves’ disease - is remission possible?

[Kari55]

My husband has seen a new endo today who told him that a chance of achieving a remission for a male are very slim and he suggested the RAI. The doctors have originally thought that he has TED but they seemed to have ruled it out now.

My husband had a bad flare up in January and his levels were sky high. They are within ranges now and he is on 2.5mg Carbimazole every other day. The endo said that the thyroid can go out of whack unexpectedly and within a very short period of time like a week. If this happens, he would be at a high risk of getting a heart attack or a stroke (my husband is 38). What are you experiences, opinions?

[Nanaedake]

I would want more information before making a decision about RAI. For example, what diagnosis has been given for the thyroid condition (which thyroid condition is it?) and on what biochemical basis was the diagnosis made ie. blood tests results for all 3 thyroid hormones, FT3, FT4, TSH and all the antibodies, TPO, TgAb, TSI and TRAB.

What data exists to evidence that men are less likely to recover or go into remission? What is the percentage likelihood based on statistical evidence for remission of overactive thyroid in men and could he cite the research so that you can read it up for yourself?

[Kari55 in reply to Nanaedake]

Thanks for your reply. Yes, you are right, he needs to ask about the data and evidence. I have never come across it but might need to do some research myself too.

Regarding the tests, he had them all checked and he has Graves antibodies.

[Fruitandnutcase]

Gosh, I haven’t heard any of that before. Wonder why he feels that men are less likely to go into remission? It must have been a terrible shock for you both to be told that.

I imagine his endo is talking about a thyroid storm which can come out of the blue and which is really serious.

Could your husband ask to speak to a cardiologist for a second opinion?

I was always being told that should my treatment not work then I could have RAI (which I didn’t want) but heart attacks and strokes were never mentioned - on the other hand I was a 60 something femal and not a 38 year old young man.

If there is no option what about a total thyroidectomy instead? Or could he try one last round of block and replace treatment?

Hopefully someone will come along soon who knows more.

[Kari55 in reply to Fruitandnutcase]

Thank you! Yes, it is a bit of a shock to be told this but we had so many bad news this year with my husband’s health and failed IVF that I guess we are used to it.

He said that my husband had a thyroid storm in January hence the chance of having another one is high and therefore the risk of heart attack too. I don’t know what levels qualify a patient for thyroid storm but his levels were very high and he was taken in an ambulance with a suspected heart attack then (which was ruled out).

He has never had a block and replace treatment and this was never suggested.

It’s an awful illness as all autoimmune conditions.

[MaisieGray]

Kari55 This may be one source of the Endo's advice to your husband:

"As males and younger patients are more likely to fail to respond to medical treatment, and male patients are likewise less likely to respond to a single dose of radioiodine, we suggest that those groups with low remission rates should be offered definitive treatment with radioiodine or surgery soon after presentation and that the value of higher initial doses of radioiodine in males be evaluated."

Age and Gender Predict the Outcome of Treatment for Graves’ Hyperthyroidism 2000 Allahabadia et al

academic.oup.com/jcem/artic...

[Kari55 in reply to MaisieGray]

Very interesting, thank you for this! It looks like this endo is aware of this study.

[HLAB35]

Possibly some protection is offered by Oestrogen in females as it can block T4 conversion to T3. Vets are known to use Acetyl-L-carnitine for hyperthyroid dogs. It has been shown in studies to enhance the effectiveness of carbimazole. Look it up, as it is an amino acid that is available for bodybuilders. It has a protective effect on the heart and 'filters' thyroid hormone.

[Kari55 in reply to HLAB35]

Thank you! Yes, we even bought it but found that my husband’s level were going a bit too low so he stopped it. As the doctors don’t believe in this I can’t find proper guidelines on how to use it but will try to explore it again.

[HLAB35 in reply to Kari55]

Well, I'm not surprised that they have not been encouraged (pharmaceutical puppets) to seek knowledge of cheap unliscensed alternatives to drugs.