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Is total ablation with radioactive iodine the right treatment for Grave's disease?

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Posted on Mon, 25 May 2015
Question: I saw my endocrinologist yesterday and she confirmed through radioactive Iodine scan that my thyroid is enlarged, cystic, and overactive. Current TSH .003, T4 2.25. for blood work. T3 normal range. She is recommending total ablation with radioactive iodine. I had read about injection of cysts and not killing off entire thyroid. Are either of these possibilities? Are injections done in current US medicine? Can the throid be only partially killed off? She says US practice is overkill so I don't have to have ablation again. I would like to try and save some of it so I don't have to take synthroid foreever. What do you think?
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Answered by Dr. Shehzad Topiwala (1 hour later)
Brief Answer:
Thyroid

Detailed Answer:
I understand what you are saying.

Ablation of cysts/nodules with alcohol is practiced in few centers in USA and indeed worldwide.

Let me clarify a few things first.

In your medical history it says Graves disease. It also mentions allergy to PTU.

Now when the radio-active iodine uptake and scan is performed it typically shows one of the two (and not both) ie either Graves disease or a 'Multi Nodular Goiter' (MNG), although nodules/cysts can be present in a thyroid affected by Graves disease too.

So first one needs to ascertain the cause of the overactive thyroid in your case.

Regarding the likelihood of becoming permanently hypothyroid (and requiring synthroid type medication forever), it is high in both instances if ablation with radio-active iodine is done. However there is no test in the world that can 100% predict the outcome, but the vast majority will not have any functioning thyroid left.

Sometimes even a second or rarely a third radiation treatment becomes necessary but your doctor is correct in stating that a robust dose is given in the first attempt that often is sufficient.

In either Graves or 'toxic' MNG (toxic is the term used to describe a thyroid gland in with multiple nodules are over-active, in contrast with non toxic where it does not produce excessive thyroid hormones and the TSH is normal), treatment with alcohol is unlikely to work. it has been tried in research setting and found to work best when there is only a limited number (typically one) of overactive thyroid nodules.
Another such treatment option is laser.

But these two methods are not used for Graves nor for TMNG as they are not effective.

Plain cysts sometimes resolve after aspiration ie removal of the fluid from them using a fine needle procedure. but sometimes they re-occur


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Shehzad Topiwala (11 hours later)
Thank you for the explanation and help.

XXXXX
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Answered by Dr. Shehzad Topiwala (4 hours later)
Brief Answer:
Follow up

Detailed Answer:
You are welcome. Best wishes
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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Is total ablation with radioactive iodine the right treatment for Grave's disease?

Brief Answer: Thyroid Detailed Answer: I understand what you are saying. Ablation of cysts/nodules with alcohol is practiced in few centers in USA and indeed worldwide. Let me clarify a few things first. In your medical history it says Graves disease. It also mentions allergy to PTU. Now when the radio-active iodine uptake and scan is performed it typically shows one of the two (and not both) ie either Graves disease or a 'Multi Nodular Goiter' (MNG), although nodules/cysts can be present in a thyroid affected by Graves disease too. So first one needs to ascertain the cause of the overactive thyroid in your case. Regarding the likelihood of becoming permanently hypothyroid (and requiring synthroid type medication forever), it is high in both instances if ablation with radio-active iodine is done. However there is no test in the world that can 100% predict the outcome, but the vast majority will not have any functioning thyroid left. Sometimes even a second or rarely a third radiation treatment becomes necessary but your doctor is correct in stating that a robust dose is given in the first attempt that often is sufficient. In either Graves or 'toxic' MNG (toxic is the term used to describe a thyroid gland in with multiple nodules are over-active, in contrast with non toxic where it does not produce excessive thyroid hormones and the TSH is normal), treatment with alcohol is unlikely to work. it has been tried in research setting and found to work best when there is only a limited number (typically one) of overactive thyroid nodules. Another such treatment option is laser. But these two methods are not used for Graves nor for TMNG as they are not effective. Plain cysts sometimes resolve after aspiration ie removal of the fluid from them using a fine needle procedure. but sometimes they re-occur