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Thyroid (Expert Forum)
Are Sub-thyroidectomies a good idea?
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
Questions in the Thyroid forum are answered by Dr. Mark Lupo. Topics covered include goiter, graves disease, Hashimoto's thyroiditis, hyperthyroid, hypothyroid, thyroid cancers, thyroiditis, and thyroid stimulating hormone (TSH).
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Are Sub-thyroidectomies a good idea?
by one_hyper_chic_13, Jun 12, 2007 12:00AM
Dear Doctors:
I have had Grave's disease for a few years now, and have been recieving treatment for the 1 1/2 yrs--PTU 300mg a day. My thyroid levels are still 1 1/2 -2 times overactive, down from a level that was off the charts when I began treatment. My liver function is normal.
I have read up a lot about RAI and the one reason I am very scared to go that route is with the Grave's Eye disease. I have read and seen horrific pictures of people's eyes becoming completely disfigured after RAI. My eyes were bulgy before and I'm scared that I could be at a high risk for the RAI affecting my eyes. They are not bulgy now after the PTU, however...
I have read of sub-thyoidectomies and it seems that this would be a wise decision to leave some so that maybe I might not need any drugs in the future. However, after talking with the leading surgeon at Beaumont Hospital, he told me that he had never done one in the 14 years he has practiced. I have no cancer cells or problems of any kind with my thyroid except for it being exceptionally overactive. Do you think that a sub-thyoidectomy is a wise decision, or is that surgeory too unreliable/unstable/risky? Also, my doc said there was a 70% chance of turning hyper- again in the next 10 years with the sub-T. Is that a huge problem if I am just a little hyper-? Also, how likely is it that after becoming hypothyroid that I would gain a lot of weight?
What might your suggestion be as a treatment?
I have had Grave's disease for a few years now, and have been recieving treatment for the 1 1/2 yrs--PTU 300mg a day. My thyroid levels are still 1 1/2 -2 times overactive, down from a level that was off the charts when I began treatment. My liver function is normal.
I have read up a lot about RAI and the one reason I am very scared to go that route is with the Grave's Eye disease. I have read and seen horrific pictures of people's eyes becoming completely disfigured after RAI. My eyes were bulgy before and I'm scared that I could be at a high risk for the RAI affecting my eyes. They are not bulgy now after the PTU, however...
I have read of sub-thyoidectomies and it seems that this would be a wise decision to leave some so that maybe I might not need any drugs in the future. However, after talking with the leading surgeon at Beaumont Hospital, he told me that he had never done one in the 14 years he has practiced. I have no cancer cells or problems of any kind with my thyroid except for it being exceptionally overactive. Do you think that a sub-thyoidectomy is a wise decision, or is that surgeory too unreliable/unstable/risky? Also, my doc said there was a 70% chance of turning hyper- again in the next 10 years with the sub-T. Is that a huge problem if I am just a little hyper-? Also, how likely is it that after becoming hypothyroid that I would gain a lot of weight?
What might your suggestion be as a treatment?
Doctor's Answer
by Mark Lupo, M.D., Jun 12, 2007 12:00AM
, Jun 12, 2007 12:00AM
Would not recommend a subtotal as there is a risk of recurrent Graves with re-growth of theyroid tissue -- as your doc has already told you. Near-total is the surgery of choice.
Eye disease after I-131 is not common but does occur -- but is entirely prevented with using prednisone for about 7 days before I-131 and 3-4 weeks after (sometimes longer).
If you do surgery, ask to be prepped w/ Lugol's solution to decrease blood flow to the thyroid gland.
Any way one successfully treats hyper will normalize thyroid levels and in turn bring the resting metabolism back to what it should have been -- ie if you don't watch the intake closely, you will gain some weight.
Eye disease after I-131 is not common but does occur -- but is entirely prevented with using prednisone for about 7 days before I-131 and 3-4 weeks after (sometimes longer).
If you do surgery, ask to be prepped w/ Lugol's solution to decrease blood flow to the thyroid gland.
Any way one successfully treats hyper will normalize thyroid levels and in turn bring the resting metabolism back to what it should have been -- ie if you don't watch the intake closely, you will gain some weight.
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