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  • Does my doctor's treatment plan make sense?

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    Old 05-16-2013, 08:34 PM   #1
    Hedgehog25
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    Does my doctor's treatment plan make sense?

    I was diagnosed earlier today with hyperthyroidism (TSH below .006, free T4 high, T3 uptake high), and the diagnosis was made by my family practice physician. He asked me if I would rather be referred to an endocrinologist, but I just kind of shrugged and he said he thought he could get it under control.

    For the next month, he wants me take 20 mg/day of Tapazole. Does this sound like too much? I like to run every day and workout at the gym, so I definitely don't want to be treated to the point that I plunge into a hypOthyroid state. Will Tapazole actually kill my thyroid, or will it just temporarily prevent it from producing thyroid hormone?

    I was surprised that he didn't mention anything about testing for antibodies. When I asked him about it, he said the cause of my hyperthyroidism "really didn't matter" since the treatment plan (at this early stage) would be the same regardless.

    He wrote me an order for a blood test since I wanted to know what was causing this (especially since I am an otherwise healthy 25-year-old male with no family history of thyroid issues), but he wants me to get it done in 3-4 weeks after the Tapazole has had a chance to take effect.

    So what do you guys think? Does my doctor's treatment plan make any sense?

    Also... will the Tapazole completely shut-off thyroid hormone production, or will it just block some of it?

    Thanks...

     
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    Old 05-17-2013, 04:06 PM   #2
    Hedgehog25
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    Re: Does my doctor's treatment plan make sense?

    Just giving this a quick bump - anyone got any opinions/advice?

     
    Old 05-17-2013, 04:56 PM   #3
    midwest1
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    Re: Does my doctor's treatment plan make sense?

    If I were hyperthyroid, I would want an anti-thyroid drug like Tapazole as my treatment of choice. Some doctors immediately push radioactive iodine ablation, but that's IMO a very unwise decision. ATDs work by preventing the synthesis of thyroid hormone by the gland. It will not, however, affect already circulating T4/3 in the blood. Therefore, as your circulating levels get used up, you could become hypothyroid if there is no adjustment downward in the dose. Close watch must be kept on TSH, free T4, and free T3. ATDs allow the possibility of lengthy remission from the hyperT state. RAI ablation permanently destroys the thyroid gland and renders the patient permanently dependent on exogenous hormone. Remission is always better than destruction.

    Tapazole works best when taken in 3 separate doses taken at approximately 8 hour intervals in order to keep the concentration steady. If your MD didn't mention that, ask him or a pharmacist about the wisdom of dividing the dose this way.

    It's vital to check for TSI antibodies if you ever decide to accept RAI ablation. But again... I think it's unwise to use that option as anything but a last resort. Otherwise, I suppose your MD is technically correct that it doesn't matter about antibodies.

    If you want a great resource for newbies on the function/dysfunction/treatment of the thyroid gland, get yourself a copy of Thyroid for Dummies by Dr. Alan Rubin. You can also read our Thyroid Information sticky thread for more on the subject.
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    Last edited by midwest1; 05-17-2013 at 04:58 PM.

     
    Old 05-17-2013, 05:41 PM   #4
    Hedgehog25
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    Re: Does my doctor's treatment plan make sense?

    Thanks for the info and advice. I guess I will just stick with the family doc I've been seeing. I just wanted to make sure that an endo wouldn't do anything differently.

    It's funny you mentioned to take it 3 times per day, because my doctor specifically said that it would be convenient since I'd only have to take it once per day.

    BTW, what is your opinion on the 20mg starting dose? Too high/low, or right on target?

     
    Old 05-18-2013, 09:36 AM   #5
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    Re: Does my doctor's treatment plan make sense?

    Please understand that I'm not as well-versed in hyperT as I am in hypoT. From what I do understand, 20 mgs would be a pretty standard starting point.

    As for the 3X vs. once a day dosing, I may be mistaken. But the official prescribing information for that drug does specifically mention the 3X/day method.
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    Old 05-18-2013, 10:51 AM   #6
    Hedgehog25
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    Re: Does my doctor's treatment plan make sense?

    Quote:
    Originally Posted by midwest1 View Post
    Please understand that I'm not as well-versed in hyperT as I am in hypoT. From what I do understand, 20 mgs would be a pretty standard starting point.

    As for the 3X vs. once a day dosing, I may be mistaken. But the official prescribing information for that drug does specifically mention the 3X/day method.
    Thanks, I guess I'll just give this doc's plan a shot. My only fear is going from my current state of being hyperT and getting exhausted during exercise, to going to a hypoT state and still not really being able to exercise because of the same symptom.

     
    Old 05-18-2013, 01:09 PM   #7
    midwest1
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    Re: Does my doctor's treatment plan make sense?

    Anticipate the need for constant monitoring with labs and perhaps several dose adjustments to keep levels constant. There is no one-size-fits all plan that fixes it lets you be done with it. You will have ups and you will have downs. As long as your MD knows how to manage the dose well, you'll be fine.
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    Old 06-05-2013, 07:53 PM   #8
    awondering1
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    Re: Does my doctor's treatment plan make sense?

    I have hyperthyroidism as well (due to Graves), and take Methimazole. From what I remember, the other medicine - PTU is the one that is most often given in split doses. In the beginning, at the highest dose of Methimazole, mine were split in two doses daily- but my endocrinologist said he was recommending that because I was having nausea/vomiting/stomach issues.

    I would, however, recommend seeing an endocrinologist. It's a roller coaster ride and I think an endocrinologist would be better equipped to handle it.

    Research and ask for suggestions for good endocrinologists in your area. At the start of all of this for me, I was just sent to one and I was fortunate enough to go to one that listens to me. I, too, don't want to become hypothyroid at the end of all of this.

    Do your research, ask questions, and stay informed -- that's the best advice I can give you. I spent countless hours reading and researching in the first few months (and still do sometimes).

     
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