Guest guest Posted May 4, 2003 Report Share Posted May 4, 2003 Hi everyone, as always I aprpeciate reading all your posts about your experiences. I started tap at 10mg last month and after 4 weeks I had a slight improvment and my Dr. decided to raise my dose to 15mg. He says the current thinking is (and I do have an article from a medical mag on this too) that starting at a lower dose (and going up if needed) can be just as effective as starting higher, plus with less side effects. I did notice a differance adding the 5mg in.. felt out of focus, restless yet I didn't know what to do with myself, for 2 days. Feeling fine now though. So at the first check up with my Dr. after being on tap for only a month he starts to talk about RAI (I laughed on the inside) He says if there isn't a significant improvment next month he will send me to an endo to talk about my options... well, I'd be happy to see an endo but there is no way after only a few months on tap I will drop it and go for RAI. My questions is this... if I do have to consider options down the road. People say RAI doesn't get to the root of the problem, you kill the thyroid but that doesn't help the autoimune side of things... well if you have surgery and remove part or all of the thyroid isn't that the same thing? You aren't getting to the root of the problem. How do these 2 treatments differ in this regard? I do read about the other problems with RAI and frankly at this point I would opt for surgery. I feel a difference in my eyes and did get checked out, the Dr said I don't have the start of TED but as we all know, we know our bodies best and my eyes are not 'normal'. Reading 's post and seeing her pictures I will try to avoid RAI given what I feel are my symptoms. Thanks for reading, I'd appreciate any feedback, BC Canada Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2003 Report Share Posted May 4, 2003 -----BEGIN PGP SIGNED MESSAGE----- Hash: SHA1 Irvine wrote: > > My questions is this... if I do have to consider options down the road. > People say RAI doesn't get to the root of the problem, you kill the thyroid > but that doesn't help the autoimune side of things... well if you have > surgery and remove part or all of the thyroid isn't that the same thing? > You aren't getting to the root of the problem. How do these 2 treatments > differ in this regard? Quite right, it isn't the root of the problem, if any organ is to blame (and that isn't one hundred percent clear) it is the thymus, but as far as I know having that cut out isn't an option, although in the early days they would zap the thymus with radiation as well. These over aggressive radiation treatments were the cause of a lot of later misery that still surrounds us today. However if you have an autoimmune response to thyroid tissue (typically that can be to TSH receptors, TPO, thyroglobulin), thyroid activity will typically aggrevate that immune response, as will leaving damaged thyroid tissue behind. The principal difference is thus (presumably) that surgery doesn't leave the damaged tissue behind to tigger an autoimmune response. In terms of eye disease, antithyoid drugs carry the least risk, surgery is marginally riskier than ATDs but people rarely discuss that, but RAI carries quite a substantial risk of causing or aggrevating the eye disease. We do know that being non-euthyroid (hyper or hypo thyroid) increases the risk of TED, so we assume no treatment is worse than antithyroid drugs in this regard. Elaine has discussed this issue in the past, see archive, the consensus being that untreated Graves commonly led to eye disease, thank goodness we've escaped those dark ages. Indeed surprisingly little is known about untreated Graves diseases as it is so dangerous (mortality(?) is somewhere between 11% and 100% according to the literature) no untreated control groups can be used, so we are left with mainly victorian medical literature. The thyroid history site is attempting to collate and make available what little is available www.thyroidhistory.net The average TSI (antibodies causing Graves) levels are typically elevated immediately after RAI and stay elevated for nearly 2 years. In surgery I've only seen reference to TBII (one of the TSI), the levels of which drop quickly and dramatically following surgery (on average again, some peoples don't - but then some people have thyroid tissue the surgeon never finds - you have to work with averages and understand the variations). (pretreatment) TBII is predictive of success of both surgery and RAI in terms of recurrence of thyrotoxicosis, high TBII level, high risk of recurrence. It has been suggested it be used to determine dose of I-131, or how aggressive to make the surgery, but this approach hasn't yet made it into practice as far as I know - I suspect it just needs someone to run a trial and show it works (or it doesn't), and everyone will happily follow if it works. Mediboard chat time... www.mediboard.com Simon -----BEGIN PGP SIGNATURE----- Comment: Using GnuPG with Mozilla - http://enigmail.mozdev.org iD8DBQE+tXJdGFXfHI9FVgYRAkvxAJ9Ts5pj7SYd9xQ4kaCv+4iLNuFIrACgvTtT 6FGv/vUyjTaHK4/nZai0BVY= =YDKt -----END PGP SIGNATURE----- Quote Link to comment Share on other sites More sharing options...
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