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Going for RAI tx next week... Diet?

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Old 01-07-2013, 11:15 AM   #1
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Going for RAI tx next week... Diet?

Hi all,

I've had hyperthyroidism with Graves' disease (and slightly, slightly swollen eyes) since I was 16 (I'm 22 now) and it has been well controlled on Methimazole, up until recently (I switched from 20mg/day to 10mg/day). I've finally decided to get RAI done, and it is scheduled for 1/18/13. I start the low-iodine diet on 1/11/13 and I stop taking Methimazole on 1/14/13. Just to be clear, I do plan on reviewing everything I'm about to ask with my doctor prior to or during treatment, but I wanted to hear from others that have gone through this as well.

First, the weight gain. I, like probably many others, am terrified of gaining weight. I'm normally a very healthy and active person, but I've since been relatively inactive because I've had major ankle surgery in late November. I'm just getting back into swimming and cycling, plus I'm looking into getting a rowing machine for some more low-impact, higher-intensity workouts. Obviously, I'll need to take at least a few days off from these activities post-RAI (well, the swimming, at least), but I do have a stationary bike at my house that I'll be able to use. As long as I work on portion control and I continue to exercise, will I gain a ton of weight or should I be okay? The weight issue is also big for me because I do have congenital heart disease (I have a repaired mitral valve -- done exactly 16 years ago today). My checkups are always great, but of course I know that excess weight can have detrimental effects on my heart. Diabetes also runs in my family, which is why I want to continue to stay thin.

I'm a very healthy eater. I'm big on fruits and veggies, organic chicken, and salmon. I also like whole wheat pasta or organic brown rice with some of my meals. Will I still be able to eat all of these things? I know I'll have to avoid things like salmon, etc. during my low-iodine diet, but how long should I stay on the low-iodine diet and when can I return to eating seafood? I've read that I will have to avoid things like spinach, cruciferous veggies like broccoli (which breaks my heart), and even fruits like strawberries and peaches. Is this true? I know I can't believe everything I read on the internet, so obviously I plan on asking my doctor about that, but of course I don't want to jeopardize my thyroid health. Finally, I drink very little dairy, but I do have ankle instability due to very, very low grade arthritis. Obviously, I want to have some calcium in my diet in order to keep up with the strong bones. Should I drink more milk (non-fat), or would something like a calcium supplement be better?

Can anyone else bring in some of their experiences with RAI in terms of weight gain, nutrition, etc.? I know I won't be put on Synthroid for at least a few weeks (and I do plan on getting very regular checkups via bloodwork, etc.), so I just want some coping strategies and advice on how to deal with this. I tend to have a lot of anxiety when it comes to medical procedures thanks to my past medical experiences, and I keep canceling the RAI and I don't want to do this now.

Thanks for all the help!!

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Old 01-07-2013, 12:07 PM   #2
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Re: Going for RAI tx next week... Diet?

I know your question was mainly about weight gain, but the more important concern should be for your thyroid eye disease. Has anyone advised you that there's a good chance it will worsen after RAI? You seem to have taken your time deciding on RAI, but I have to wonder if you've heard all the cons of the issue. If you've only heard the endo's point of view (probably just the "pro" side), you'd do well to investigate the facts - like this one regarding eye disease - before going ahead. The book, Graves' Disease: A Practical Guide, will show you what I'm talking about.

I'm curious why you'd choose ablation, since your disease has so far been pretty well controlled with methimazole. If you were recently able to reduce your dose, it may mean you're headed for a remission, in which case there'd be no need to nuke your gland and make yourself hypothyroid for no good reason.

Trust me and the rest of the hypoT regulars on this board; being hypothyroid is no better than being hyperthyroid if your MD doesn't know how to treat it well. Most don't. Most MD's will want keep you undertreated. They will use lab results to monitor your dose and will deny that any of your symptoms are related to your thyroid blood levels. They'll be happy to allow you to be sick as long as your lab levels are anywhere within range, even if they are too low for your particular needs. Undertreatment greatly increases the chances for not just obesity, but mood disorders, infertility, osteoporosis, heart disease, high cholesterol, digestive disorders, muscle and joint pain... You name it, low thyroid has a hand in most all of it.

If you still plan to go ahead, your chances of obesity are probably not any higher than they'd be if you had a perfectly healthy thyroid as long as your MD optimally replaces your thyroid needs with the exact dose for your body's needs. As I said, the chances of that happening are not favorable unless you educate yourself about how to guarantee that. Hypothyroid patients who want to leave it all up to the MD are usually disappointed. Educated ones, who understand all the ins and outs and who are willing to insist on what they need from the MD can do alright.

Whatever you decide, I hope it's the best option for you and that it works out well.
"We can complain because rose bushes have thorns, or rejoice because thorn bushes have roses." Abraham Lincoln

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