When you're diagnosed with Graves' disease or hyperthyroidism, your doctor may tell you that the best (or only) treatment is radioactive iodine -- referred to by the acronym RAI. Some people refer to RAI as the "radioactive cocktail," "chemical thyroidectomy," "ablation" or "chemical surgery." Unless you specifically ask if there are other options, you may never be told there are other treatments.
Is That So?
Radioactive iodine is one of several treatment options for Graves' disease and hyperthyroidism. Other treatments include antithyroid drugs, and surgical removal of part or all of the thyroid.
In the United States, RAI is the treatment preferred by endocrinologists for Graves' disease and hyperthyroidism. One survey found that 69% of North American endocrinologists prefer RAI over antithyroid drugs for initial treatment of adults with Graves' disease and hyperthyroidism.
RAI, however, is an irreversible treatment that may have some side effects, and is infrequently used in Europe and other parts of the world. Instead, antithyroid medications are almost always tried as a first-line treatment. In fact, among Europe's top endocrinologists, 84 percent recommend antithyroid drugs, followed by thyroidectomy (10 percent), and only 6 percent recommend RAI. Outside the U.S., RAI is also rarely used on women of childbearing age, and almost never on children.
Among European experts, if a first course of antithyroid drugs don't resolve the hyperthyroidism, then 43 percent recommend surgery, 32 percent suggest another course of antithyroid drugs, and only 25 percent then recommend RAI.
What It Means For You
In the United States, the majority of practitioners push for RAI as the first course of treatment. How can you decide which way to go?
First, be sure that your Graves' disease and hyperthyroidism is confirmed by blood tests, imaging tests and antibody panels. Some patients are istakenly diagnosed as having Graves' disease, when they are experiencing a temporary hyperthyroid episode during Hashimoto's disease.
Second, find a doctor you can trust and who will be your partner in decision-making. You'll want to understand and discuss your options. If you are not in an acute or life-threatening situation, and your doctor isn't willing to discuss anything other than RAI, then it's time to consider finding a new practitioner.
Third, understand that if you work with the right practitioner on an antithyroid drug protocol -- and possibly complemented by a dietary and nutritional supplement approach -- you may be able to achieve remission and require no permanent, irreversible treatment.
Fourth, understand the implications of treatments. For most patients, RAI or surgery means a lifetime of resulting hypthyroidism -- an underactive thyroid, that will require lifelong treatment and monitoring.
Only you and your doctor can decide together which way to proceed, but the most important thing is to be informed, and to work with a practitioner to guide you.
Source: Living Well With Graves' Disease and Hyperthyroidism: What Your Doctor Doesn't Tell You...That You Need to Know, by Mary J. Shomon, HarperCollins, 2005
Mary Shomon, About.com's Thyroid Guide since 1997, is a nationally-known patient advocate and best-selling author of 10 books on health, including "The Thyroid Hormone Breakthrough: Overcoming Sexual and Hormonal Problems at Every Age," "The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss," "Living Well With Hypothyroidism: What Your Doctor Doesn't Tell You...That You Need to Know," "Living Well With Graves' Disease and Hyperthyroidism," "Living Well With Autoimmune Disease," and "Living Well With Chronic Fatigue Syndrome and Fibromyalgia." Click here for more information on Mary Shomon.