General Medicine

» Lorrie76 - Medication

Hi,

I have been taking Tapazole for over a year now 5 a day of 5 mg. My blood tests are normal now when do I cut back or stop. I have Strabismus and the surgeon is hoping to correct this in May 2007 can't wait. He has also suggested I see another internist for a second opinion regarding treatment options. Should my Thyroid be radiated ?

-- posted by Lorrie76

» Elaine Moore - Medication

In response to Medication posted by Lorrie76:
Hi Lorri,
The usual starting dose for Tap is 10-30 mg day. This dose is used for the first 6-8 weeks, at which time the FT4 level should be normal. At this time the dose is cut and over time gradually reduced. By 8 weeks after starting meds, the recommended dose is 2.5-10.0 mg daily.
The problem with doses that are too high is that although levels may be in range, if they're too low for your body's needs you'll have symptoms of hypothyroidism and be at risk for thyroid eye symptoms.
For most people, TSH will remain low, often to .01 mu/L for a long time. This doesn't mean you're still hyperthyroid. Usually, if TSH has risen into the normal range, you're hypothyroid from being overmedicated.
I'd suggest that you get a copy of your last lab results and look carefully at your FT4 and FT3 levels. You want them to be near the high end of the range. Like with a range of 0.8-1.8 ng/dl for FT4, you'd want a level of at least 1.6.

I'd start with checking levels and then making sure you're on the lowest dose of Tap needed to keep FT4 where you want it. I suspect this will help your eye symptoms as well.
When eye symptoms are present, it's best to avoid radiation because of its tendency to worsen eye symptoms.
Best, Elaine

» snickers1 - Question about treatment

I was recently diagnoised with a mild case of Graves Disease and started taking 50mg of PTU twice a day. I am anxious to get pregnant within the next 6 months to a year. I am tempted to go the RAI route instead, since the out come is more successful. I am willing to wait the 6 months after treatment to try to conceive. I've heard mixed information about being on PTU and getting pregnant. Any suggestions or information would be helpful. My endo did say that I have a good chance of remission with PTU, but it's hard to tell how long it will last after going off meds. And how long I would have to be on the PTU for it to work.
Thanks,
Carolyn

-- posted by snickers1

» Elaine Moore - Question about treatment

In response to Question about treatment posted by snickers1:
Hi Carolyn,
I'm puzzled by your comment that treatment with RAI is more successful. In what regard?
Hyperthyroidism is definitely alleviated, but the autoimmune disorder itself worsens because of the dramatic immune stimulation.
Also, for many of us the subsequent hypothyroidism is far worse than the initial hyperthyroidism. And most sources recommend waiting at least one year after RAI to conceive. In most European countries, RAI isn't even offered to women of childbearing age.

The general rule with PTU is that as long as the dose is below 200 mg daily, it's safe in pregnancy. However, if you're only on 100 mg now, and your dose will be reduced about 6 weeks after being on meds as recommended, you'll be on a small amount of PTU. Furthermore, in the second half of pregnancy thyroid levels fall due to estrogen's influences. Most people on PTU are taken off meds or the dose is reduced during pregnancy. Many people with GD also go into remission during pregnancy although some may relapse during the postpartum period.

The amount of time for remission varies but because Graves' is a self-limiting disorder, destroying your gland to resolve hyperthyroidism faster doesn't seem as if it would be in your best interest.
RAI causes cell mutations that are passed on to progeny, and hypothyroidism has a detrimental effect on fertility and fetal maturation. I think you may want to do more research before deciding on the best course of action for you and your future family. Best, Elaine

» snickers1 - Question about treatment

In response to Question about treatment posted by daisyelaine:
Thank you Elaine for the information. The RAI does scare me, especially since I do want to get pregnant within the next year. I will definintely keep that in mind.
Carolyn

-- posted by snickers1

» tuesdaykopp - Hashitoxicosis

Hi,
I'm really confused! I was diagnosed in Feb 06 with Graves Disease, after I was taken to the hospital with tachycardia and severe anxiety (they tested me for thyroid functions). However, my levels are always bordering normal...with spikes of too much or too little depending on the day I have my blood tested. My symptoms, however, are horrible. Most days I feel like I have mono or something, and I can feel my thyroid giving 'bursts'. My endo doubled my Inderal LA to 160mg and it's not helping, but I'm still only on 5mg tapazole ONCE per day (my t4 is good most days). She will NOT test me for the Hashi antibody and maintains you can't have both of the antibodies at the same time. What can I do?

-- posted by tuesdaykopp