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Treatment

Typically, the first treatment prescribed is Anti-Thyroid Drugs (ATDs). If there is little to no response to ATDs, the doctor will typically discuss the option of RAI or Surgery. The concern is that long term hyper symptoms can cause serious damage to major organs; such as, the heart and kidneys.


ANTI-THYROID DRUGS (ATD's)


The first treatment option is typically ATDs with the goal of remission. ATDs block the thyroid from producing excessive thyroid hormones and in response the antibodies no longer see the thyroid under attack so they back off. It's important to note that it takes about six to eight weeks for the medication to be effective because it takes that long for the excess hormones to cycle through the system.


Below are the typically prescribed drugs.


  • PTU: Propylthiouracil (USA)

  • MMI: Methimazole (USA)

  • Carbimazole (Europe & Asia) Once absorbed in the body is converted to Methimazole.

  • Neomercazole - Trademarked brand name of Carbimazole.

  • Beta Blockers such as Propranolol and Atenolol are often used to help with rapid heart rate, nervousness, and tremors.



THYROID SURGERY (TT)


Items to bring on the day of surgery:


  • Download soothing and relaxing music on your phone or tablet.
  • Eye Mask - nurses love to turn the light on bright at 3am!
  • Neck Pillow - great neck support for after surgery & sleeping.
  • Button up shirts - you are probably not going to want to try and pull a shirt over your head for about a week.



WHAT TO EXPECT AFTER SURGERY


  • Expect to have a sore throat and a diet consisting of ice chips for the first few hours after surgery.

  • Some doctors place a drainage tube at the end of the incision. It looks pretty strange but I promise there is no pain involved. Typically it will be removed within 24 to 48 hrs after surgery.

  • You will have several staples or tape across the incision. Neck mobility will be limited but typically there is little pain other than a little discomfort from the incision.

  • Your levels will be high for the first 3 to 5 days after surgery from the extra production of hormones produced by the thyroid prior to the thyroidectomy added with the thyroid replacement medication the doctor will start you on following the surgery.

  • After the extra hormones produced by the thyroid have cycled through your system, often a person will feel a sudden low or drop in energy - much depends on how hyper your thyroid is before surgery. Your body will need time to adjust to the thyroid medication and your doctor should be taking regular blood tests - typically every 4 to 6 weeks for the first 6 months.



Iodine-131 Radioactive iodine (RAI)


Preparing for RAI Treatment:


Typically a doctor will advise their patient to stop taking ATDs 5-7 days prior to RAI and to avoid all foods with iodine two weeks prior to the treatment date.


Usually, the person is in complete isolation from pets, children and adults. They cannot share a bed or bathroom for several days. All items touched must be disposed of or washed separately with hot water. How long a person is isolated depends on the amount of RAI prescribed by their doctor and whether or not they have young children in the home. It's usually about 1 day but can be several. After that, the person is usually told to keep the same distance they would if they had the flu.


Preparing for RAI again depends on the how much radiation is given. Some people will do what is minimally necessary and others will take every precaution possible. Everyone I've spoken to says that a great support team is very important and makes a huge difference in recovery.


The list is a general list of what the doctor may give you and what others have suggested:


  • Prepare and freeze meals for about a week
  • Paper towels, plates, cups and utensils
  • A neck pillow is a great thing to have for watching and relaxing
  • An eye mask is a must so that you can rest peacefully during the day
  • Buy a few new books, magazines or crossword puzzles
  • Lemon Drops help to prevent or soothe a sore throat
  • Case of bottled water - drink lots and lots of water to flush the radiation out
  • Disinfectant wipes
  • Plastic bags for the phone, TV remote and other small items
  • Buy cheap or use old towels, mattress pad and linen


Talk with the hospital and ask if there is a hotel close by that has protocols for someone who is having RAI treatment. Since you have to spend time isolated and, depending on your household, it might be a little more relaxing to just spend the time alone in a hotel room without worrying about bed sheets, linen and plastic utensils.



WHAT TO EXPECT DURING ISOLATION AND AFTER RAI


What you will need to do again will depend on amount of radiation you are prescribed but for the most part the following is what you should expect:


  • Daily showers if not twice daily
  • Flush the toilet at least twice after use
  • All dishes must be washed separate from others
  • Laundry should be bagged for a few days prior to washing then do so separate from others.
  • Drink lots and lots of water to flush out the radiation
  • Sore throat (lemon drops and water help)

  • Don't expect to feel anything significant right away. Typically after the first week, most people start to feel the swinging back and forth from hyper to hypo. Think of it as a tug of war - the radiation will be trying to destroy the thyroid while the antibodies will be trying to save it. This takes approximately 3 months before reaching a state of hypo - but, it could be sooner or take several months longer and possible up to a year. It depends on the severity of your Graves and the amount of radiation