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Dr. Andrew Rynne

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Diagnosed with Graves' disease via iodine test. Took methimazole. Stopped due to high liver levels. Advice

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Dr. Minal Mohit

Endocrinologist

Practicing since :1998

Answered : 804 Questions

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Posted on Tue, 19 Nov 2013 in Thyroid Problem and Hormonal Problems
Question: I eas diagnosed with Graves' disease via iodine test & blood work. Tsh was 0.01, tsi & thyrotropin receptor ab were 222 & 23 respectively. Anti top was also high. Took methimazole 5 mg 1 bid July 10-29. Stopped because of high liver levels. 10/22/13 alt 34 ggt 198 ld 119, much improved. Thyroid of 10/22 normal t3 uptake 33.84. T4 6.8 fit 2.3. But tsh is still 00.1 & my fatigue & difficulty going up the stairs & the need to continue tenormin for my rapid pulse, tells me that these are mixed messages. Graves is an auto-immune condition that affects the thyroid. I know that. My doc told me that everything was o.k. With the thyroid, when the functions (except for tsh), came back to normal. But when we did the antibodies, there is a different message. It seems that the antibodies are still busy & the graves has not cleared yet. And now that the livers have improved so much, maybe the other meds, put ( is that what it's called?) are in order for now? Please review & advise me. I'd greatly appreciate it. Thank You, XXXXXXX Rubashkin. YYYY@YYYY
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Answered by Dr. Minal Mohit 7 hours later
Brief Answer:
Graves' disease require long term management.

Detailed Answer:
Dear Ma'm, Graves' disease can be managed with medicines like methimazole, or PTU (Propylthiouracil) but mostly the side effects profile of all these drugs are similar. So if you have liver enzyme derangement with one you are likely to have it with other as well. Secondly Graves' with medicine will take 18 months to treat. Also, the other option I would suggest is to discuss about radio ablation of thyroid. Regards!
Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. Minal Mohit 20 hours later
So are you agreeing that the Graves' disease is a current condition, because of the antibodies, even though the other thyroid functions that were tested were normal? Also, is there any other thyroid function test that you would add to what I already took? Thank. And for curiousity's sake, is Graves a common condition in your practice? Thank you again for your time, XXXXXXX
doctor
Answered by Dr. Minal Mohit 3 hours later
Brief Answer:
Graves' disease is your diagnosis.

Detailed Answer:
Dear XXXXXXX

Let me answer your queries in the reverse order.

I see at least one graves' every day.

Yes that is true. Confirmatory test to diagnose graves' is not antibody presence but Radio iodine uptake test. But that being a long time consuming, alternative option is 99 technetium uptake by thyroid.

Lastly why I keep your diagnosis as Graves' disease is because your TSH is still suppressed and you are on treatment still.

It is only once you are off treatment for at least 6 months and your thyroid functions are normal without drugs that we can label you as cured. But even in that case chances of relapse, which now depend upon antibody levels, are always there.

So my advise is if you are not tolerating methimazole, PTU, please stop them all for 6 weeks, undergo 99 Tc uptake by thyroid to find out the exact functional status of thyroid and then undergo radio ablation for thyroid.

Regards!
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Minal Mohit 2 days later
First of all, thank for your interest. Second, I am currently only on Tenormin. I have not taken Meth since July 29. I ended up taking the med for 3weeks only, stopping on July 29. According to your opinion I still have Graves. My Dr. Claims that my thyroid functions are normal, the TSH will not go back to normal for awhile & I am confused about the antibodies which have improved, but are still a distance from normal (still high). According to him, I think he thinks I am cured. I wonder what the bottom line is. Your evaluation, please. I like to understand what is going on & I like to make educated decisions. As far as radio ablation, I would rather try PTU, if that makes sense, before I do that. Actually, my Doc did mention to me, when we were deciding on course of treatment, that since ther is less destruction with meds, he would prefer that, since I have a goiter that was aspirated via FNA that according to 1 opinion out of 4, was possibly hyper plastic; the opinion of Quest Diagnostics. The other opinions were from Mayo in Minnesota, Cornell in New York & Columbia also in N.Y.C. They did not agre with the hyper plastic diagnosis. My Doc opted for meds as treatment here, because he feels it's the best choice, because he would like me to do a regular biopsy & according to him, the iodine treatment would not allow for a proper diagnosis. What is your opinion? Thank you so much for your patience. I really need advice, so that I should make intelligent decisions.
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Answered by Dr. Minal Mohit 23 hours later
Brief Answer:
Need to undergo tracer uptake studies.

Detailed Answer:
Dear Ma'm,

Let us try and get things straight one by one.

1. your diagnosis? It is Graves' disease , we all agree. Now whether cured or existing still?

2. your thyroid function? your thyroid reports say it is normal i.e. euthyroid; but TSH still suppressed. Clinically you feel better. There may be relapse / there may be complete cure. But my clinical experience says Graves' is not something which gets cured in 3 weeks.

3. Your thyroid activity? FOR THIS YOU WILL HAVE TO UNDER GO TRACER UPTAKE STUDIES.

4. treatment ? Drugs are definitely better, but as you are not tolerating them you will have to think of alternatives.

Repeated FNAC in my opinion is not required.

Hope I have answered your questions.

Regards!
Above answer was peer-reviewed by : Dr. Prasad
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