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Suggest treatment for macular degeneration and overactive thyroid

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Posted on Thu, 8 Jan 2015
Question: If someone has macular degeneration and also an overactive thyroid and they take radioactive iodine to fix the thyroid problem, will the radioactive iodine zap some eye cells?
How does age affect the treatment options?
If someone is taking medication for the overactive thyroid and they stop taking it after a year, what is the probability of the thyroid flaring up again after the carbimazole(5mg) is stopped?
How does the radioactive iodine work? Does it kill the cell or just destroy the dna so that it can't make anything anymore? Does the cell die or does it just stop making stuff?
How many receptor cells are in the eye? How often do they get replaced? If a receptor cell's DNA got damaged could it still function by transmitting signals to the brain?
If the iodine is safe and wont cause cancer why are there so many precautions that the patient has to take. Ie dont hug people etc.
I am asking these questions on behalf of another person.


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Answered by Dr. Binu Parameswaran Pillai (1 hour later)
Brief Answer:
Answers

Detailed Answer:
Good day,
Noted the concern.
Radio active iodine is used to treat Hyperthyroidism due to Grave's disease or Toxic multi nodular goiter.
Radio idoine is taken up by the thyroid follicular cells and after that Radio Iodine emits low grade radiation to the surrounding cells and destroys thyroid cells. It kills the Thyroid cells. However, there is a fear of low level radiation mutating the DNA leading to a second cancer in the future. However, current evidence shows that, such a risk is very low.

In Grave's disease, carbimazole can cure if medicine is taken for atleast 1 year. But the success rate is only 30%. So there is a 70% chance of flare up o hyperthyroidism after that.

There are TSH recptors in eyes as well. If there is a Thyroid related eye disease, radio iodine treatment can lead to worsening of thyroid disease. But this risk is specefic for Grave's ORBITOPATHY. Not for other forms of eye disease.

Radio iodine in usual doses is safe and emits very low level radiation for few days. This radiation travel only around one meter maximum outside the patient's body. This is the reason we advice patients to avoid meeting pregnant women, young kids and to avoid public places for 10 days.

In Older age, radiao idoine may not be very effective

Regards
Binu


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Binu Parameswaran Pillai (41 hours later)
Hello
We have seen another Thyroid Doctor and he recommends that we continue with carbimazole because he said that it would really knock her around as the thyroid dies and releases its hormones into the blood stream.
However he says that he will do whatever we wish and other Doctors could have different opinions.
He says that the death rate for carbimazole is 1 in 400 but he suspects that is low and it could be 1 in 1000 or even higher, he does not know.
He only knows of 2 people in his practice that have died of complications and he said he saw 35 people this morning.
She has been taking carbimazole since march this year and he said that most complications would have occurred by now.
I saw on the internet that taking radioactive iodine is similar in radioactive dose to having a GI scan.
I looked up the death rates for a GI scan and it was between 1/1000 and 1/10000
I appreciate this thyroid doctor because he was not afraid to speak his mind and say something he believed in that could be different to the conventional norm.

Do you have any figures for death rates(due to immune problems) for people taking cabimazole? Is it 1/400 or 1/1000?
Could it be possible that the death rates for taking the radioactive iodine match the death rates for taking carbimazole?
How often would you recommend a blood test being taken? Is 1 test every 3 months ok?
How long does it take for the low white blood cell problem to develop?

What treatment would you recommend for an 87 year old?

Regards
XXXXXXX
doctor
Answered by Dr. Binu Parameswaran Pillai (8 hours later)
Brief Answer:
Wrong statistics

Detailed Answer:
Hello,
I have just seen one case of liver failure with Propylthiouracil many years ago. I have treated atleat 300 patients wit Carbimazole and have never seen a death with that. Nuclear medicine also doesnt cause any death if pre treated with Neomercazole. I guess you got this death statistics from Internet, and the statistics seems to be wrong.

For an 87 year old paerson, we can start with a small dose of neomercazole and if it is causing any side effects, we can always consider radio active iodine treatment.
Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1435 Questions

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Suggest treatment for macular degeneration and overactive thyroid

Brief Answer: Answers Detailed Answer: Good day, Noted the concern. Radio active iodine is used to treat Hyperthyroidism due to Grave's disease or Toxic multi nodular goiter. Radio idoine is taken up by the thyroid follicular cells and after that Radio Iodine emits low grade radiation to the surrounding cells and destroys thyroid cells. It kills the Thyroid cells. However, there is a fear of low level radiation mutating the DNA leading to a second cancer in the future. However, current evidence shows that, such a risk is very low. In Grave's disease, carbimazole can cure if medicine is taken for atleast 1 year. But the success rate is only 30%. So there is a 70% chance of flare up o hyperthyroidism after that. There are TSH recptors in eyes as well. If there is a Thyroid related eye disease, radio iodine treatment can lead to worsening of thyroid disease. But this risk is specefic for Grave's ORBITOPATHY. Not for other forms of eye disease. Radio iodine in usual doses is safe and emits very low level radiation for few days. This radiation travel only around one meter maximum outside the patient's body. This is the reason we advice patients to avoid meeting pregnant women, young kids and to avoid public places for 10 days. In Older age, radiao idoine may not be very effective Regards Binu