question-circle Hyperthyroid

8 years 9 months ago #148447 by Huggles
Replied by Huggles on topic Hyperthyroid
My thyroid was under control for a long time (diagnosed 1994) and I was on Eltroxin. Then I fell pregnant and the blood test showed that my dosage was now too strong. So the doctor lowered the dose and it was fine again. But then after Jarrod was born when i had my levels tested again they were too low so I had the dosage increased back to my original levels. Then tested again - now the dosage was too strong again. So now she's changed me to Euthyrox 0.75mg once a day hoping for a happy medium. Haven't retested yet so can only hope it's finally right.

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8 years 9 months ago #148455 by Huggles
Replied by Huggles on topic Hyperthyroid
I suspect he wants to remove it because the "best" way to treat an over-active thyroid is to make it underactive and then put you on Eltroxin for life. And they make it underactive by either removing it (whole or part of) or by treating with radiation which 'kills' it.

Will be interested to see what the resident specialist has to say.

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8 years 9 months ago #148856 by DocJuan
Replied by DocJuan on topic Hyperthyroid
A good day to all. Since this is my first response to this list, please allow me to mention that it will be rather long-winded. There are two reasons for this. Firstly, a forum such as this is not a thorough consultation in as much as the information given is very little. For proper management suggestions, I will need a lot more information. Secondly, the thyroid is a fascinating organ, with infinite nuances in its function, disease presentation, and response to treatment. To be honest, we are barely scraping the surface in understanding thyroid disease, even in 2011, and therefore I distance myself from anyone making snap decisions on thyroid disease diagnosis and management. Patients with thyroid disease should be managed by an experienced physician and the patient should commit to a long-term relationship with her treating physician of choice.

With that introduction behind us, let me make an attempt at answering some of the concerns raised in the initial post, adding my voice to some very good advice that has subsequently been given by members.

I do note that a specific diagnosis was not confirmed. Hyperthyroidism (over-activity of the thyroid gland) and thyrotoxicosis (a more generic term including all causes of raised thyroid hormone levels, whether it be from the thyroid or not) is merely a description of a metabolic state and have specific causes. The main cause is Graves' disease. It is a condition in which the immune system ''attacks'' the thyroid. Other common causes are a toxic multi nodular goitre and a toxic nodule. In these conditions there are one or more nodules in the gland that over-secrete thyroid hormone. There are other less common causes such as various phases of thyroid inflammatory conditions, reaction to a specific heart-rhythm drug, the taking of an overdose of thyroid hormone pills, TSH secreting tumours in the brain, ovarian tumours, and certain cancers of the thyroid. Alarming as these may sound, rest assured, they are extremely rare! If a diagnosis was not made prior to the initiation of treatment it does cause a bit of a conundrum, as the best test, which is a radioactive scan (scintigram) and it is affected by treatment. It should be performed before treatment or when off of medical treatment for some time. An ultrasound (sonar) can also help, especially in the case of nodules as cause for the hyperthyroidism. Although many physicians will use thyroid antibodies to help in making a diagnosis, very few specialists in thyroid disease will use them as they more often than not lead to confusion.

On the question of the effect on fertility I must confess to have seen a great variability with some patients with seemingly no affect on their fertility, to the more common decreased fertility. This is due to an increase in sex-hormone-binding-globulin, which causes retention of oestrogen with subsequent menstrual abnormalities (either no or diminished menstruation).

With regards to treatment, there are three basic options. Medical therapy, with antithyroid drugs (as in this case), radioactive iodine destruction, and surgery. Surgery is only the first choice in cases of hyperactive nodules, in children and adolescents, in pregnancy, in those with large thyroids causing compression, in those with eye symptoms of Graves' disease, in those with allergies to antithyroid drugs (or suffering from severe side-effects of these drugs), in those with a suspicion or thyroid cancers, and of course in those who prefer it. In all other cases, surgery is the last option. (Which is unfortunate for a surgeon such as myself. Just joking). The first-line therapy is usually antithyroid drugs. It is recommended to be given for 12 to 18 months. I see and test patients at least every 4 weeks during this period, as waiting any longer to pick up problems can really be harmful and dangerous. It is important to also take very specific blood tests, namely free T3, free T4 and TSH and not only the usual total T4 and TSH. There are incidences in which a patient can react very strangely and it will be missed if just the usual tests are done.

If a patient does not respond, has side-effects, or in those in whom the thyrotoxicosis returns after the initial therapy, there are three choices. Either reinstitute the therapy, which will probably be life-long, with intense follow-up, the more usual radioactive iodine destruction, and lastly surgery.

Radioactive iodine destruction is by far the most common form of definitive treatment these days. It should be done very specifically and I might answer some questions on it later. The usual questions before embarking on this form of therapy are about the long-term effects. Especially on future reproductive ability (the ovaries are affected by radioactive iodine) and the risk of future cancers. Here I must confess a little. Doctors simply do not know the answers to these questions. There is no, what we call, level I evidence on the subject. There are only a few long-term studies and the answers they give are not unanimous. An honest answer to these questions are speculation at best. Apologies for that. Lastly it must be noted that radioactive iodine may worsen the eye problems in those with Graves' disease.

If surgery is embarked upon (only for the indications mentioned above), it must be remembered that, in the case of Graves' disease, the risk of complications are higher than in normal thyroid resections. If done by an expert, though, things usually go well. The tendency these days is for a total removal and transplantation of one of the parathyroid glands. It might sound all technical, but remember these issues and discuss them with your surgeon. The older subtotal resections are just not acceptable these days.

Again, apologies for the long-winded reply. In future I hope to be more concise. Please also visit www.youtube.com/jhklopper and click on Thyroid. These short videos are for doctors studying to become specialists, and therefore a bit difficult to understand, but might provide a lot of answers.

Juan Klopper MBChB(UP) MMed(Surg)(UFS)Cum Laude

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8 years 9 months ago #148859 by julz
Replied by julz on topic Hyperthyroid
Wow very interesting indeed and honest!

Mom of Dylan and Partner to Joerg. We live in the Beautiful Pringle Bay which is along the Whale coast, Cape.


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8 years 9 months ago #148983 by Huggles
Replied by Huggles on topic Hyperthyroid
Thanks, very interesting info.

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8 years 9 months ago #148994 by Strik*kie
Replied by Strik*kie on topic Hyperthyroid
Thank you so much, it is interesting indeed. I appreciate the time to answer these questions!

:) I know after reading it again and again i will still have some questions, so please bare with me. :blush:

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8 years 9 months ago #148998 by Simone C
Replied by Simone C on topic Hyperthyroid
Strikke are you seeing an endocrinologist? Mine is fabulous and as the doctor here says about seeing the patient every 4 weeks...he saw me every single month for a year to monitor my thyroid and graves disease (which I had). My meds were adjusted every month as my blood tests improved. We also did the free T3 and T4 every month along with everything else.

I do believe that you need to see a specialist to monitor your specific situation. We've discussed symptoms and mine and yours were not the same...so its not a one size fits all.

In the hands of a good specialist...you can get this thing under control.

I was told by my dietician that she was surprised I fell pregnant with my overactive thyroid...with the levels being what they were (no idea myself)...so according to her it can affect fertility, but as the doctor says..different strokes for different folks.

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