Thyroid Diseases, Living Well With (cont.)

MEMBER QUESTION:
My doctor told me that radiation cures Graves' disease but I have read elsewhere that you can only hope for remission with antithyroid drugs. Is this true?

SHOMON:
It depends on how you view the word "cure."

For conventional physicians, they consider getting rid of the hyperthyroidism as the cure. However, what you are doing when you receive radiation, also known as radioactive iodine or RAI treatment, is you are permanently disabling and deactivating your thyroid. So you do eventually eliminate the hyperthyroidism. However, you are trading one condition for another because the end result of RAI is almost always hypothyroidism and you will require lifelong therapy on thyroid replacement drugs.

Remission, which in this case means the absence of hyperthyroid conditions and return to normal TSH levels, is possible in about 25% of cases if patients are given a proper regimen of antithyroid drugs such as PTU, or methimazole or Tapazole. Also, adding in integrative, holistic or alternative approaches can often increase the chance that antithyroid drugs can help you achieve and sustain a remission from Graves' disease.

MEMBER QUESTION:
Are there any risks involved with radioactive iodine (RAI)?

SHOMON:
The question of whether there are risks associated with RAI is one that is very controversial. Some doctors claim it is absolutely safe and has no side effects, no lasting problems or results and they consider it a completely safe treatment for Graves' disease and hyperthyroidism. Other practitioners believe that the end results of hypothyroidism is a significant and dangerous side effect of RAI and should be a consideration in a decision to give radiation treatment vs. thyroid drugs or a third option, which is used as treatment -- surgery. Some doctors believe that radiation should never be used in a woman of childbearing age or in children.

In the United States, radiation treatment is the primary treatment for Graves' disease and hypothyroidism in the entire population. Outside the U.S., antithyroid drugs are the first choice of treatment followed by surgery or radiation, depending on the practitioner. However, outside the U.S. radiation is almost never done on children or women of childbearing age because of concerns of the long term effects of radiation on a child's development or on a woman's childbearing potential for future children.

MEMBER QUESTION:
With hyperthyroidism, what treatment do you recommend -- RAI, drugs or surgery?

SHOMON:
I don't recommend any particular treatment. What I do recommend is that you -- as a patient -- be informed, knowledgeable and have a practitioner who is your partner in getting information and making the right decisions for you.

Some patients, depending on the severity of their condition, do well with an antithyroid drug to start, followed by more holistic measures to deal with the immune system and calm down the autoimmune problem. Other patients may be in such an acute state of hyperthyroidism that an immediate permanent treatment may be called for. Surgery, for example, is often the primary treatment recommended for a woman who is pregnant, in order to avoid radiation, which is never given when pregnant, or to avoid the potential dangers to the fetus of antithyroid drugs.

So ultimately, there is no one course of action that is the right answer for everyone. Rather, it depends on your condition, your willingness to incorporate holistic and nutritional elements into your overall health program, and having a practitioner who is open-minded, knowledgeable about these options and not biased in one direction or another while helping you make the best decision possible for you.

"Ultimately, one of the most important things a patient can do is to determine which combinations of options, both nutritional, conventional, alternative and even mind/body (I swear by deep breathing, Pilates and some meditation) will help you personally achieve your best possible outcome despite your thyroid condition."

MEMBER QUESTION:
Can you elaborate on the holistic measure you keep bringing up? I am truly interested in these! Also, are there holistic treatments for hypothyroidism?

MEMBER QUESTION:
Can you tell us more about "holistic measures to deal with the immune system and calm down the immune system"?

SHOMON:
Holistic approaches to thyroid disease are varied and can incorporate everything from mind/body approaches, such as stress relief, breathing, and yoga, to dietary changes, to the use of herbs and supplements, traditional Chinese medicine and acupuncture.

When it comes to hypothyroidism or underactive thyroid, unfortunately, we do not have an herbal supplement for the missing thyroid hormone in the body. What you can do -- if you still have a thyroid -- is enhance the thyroid's ability to function using some of the essential nutrients that the thyroid needs in order to work at its optimal capacity. These include selenium, tyrosine, the B vitamins and essential fatty acids which all help the thyroid function at its best.

With hyperthyroidism, there are some herbs and nutrients that can help slow down the thyroid, making it less hyperactive. These include fluoride and soy foods.


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