By Dr. Keith Roach
Dear Dr. Roach: What is the endgame of hyperthyroidism? I am a 54 year old female, diagnosed in September 2020 with hyperthyroidism due to Graves’ disease. My endocrinologist started me on 10mg of methimazole and 100mg of metoprolol daily (my heart rate was over 100 beats per minute).
I have blood drawn quarterly. My thyroid results fluctuate, so my doctor is upping me to 15mg methimazole or back down to 10mg, accordingly. Last time I had a blood test all the readings were low again which I suspected as I felt like a zombie again but with added double vision which was not fun.
I feel like that’s how it goes, hoping that the hyperthyroid goes into remission by the end of the second year of taking methimazole because this drug can have a negative effect on the liver. If not, surgery will be recommended to remove the thyroid and I will have to take hormone replacement for the rest of my life.
I don’t feel well on 15mg and the double vision is frustrating. I haven’t seen an ophthalmologist.
I just want to remove the thyroid and get it over with so I can feel normal again. Are there other options that I don’t know about? – THAT
To respond: The thyroid regulates virtually every system in the body, so abnormal thyroid levels have many different possible effects. High thyroid levels from any cause present problems, but Graves’ disease adds an additional complication: In Grave’s disease, antibodies stimulate the thyroid to produce excess hormones, but they can also cause a unique eye condition.
The same antibody that stimulates thyroid growth (causing goiter, an enlarged thyroid) can also stimulate the growth of fat and connective tissue in the back of the eye, which can push the eyeball upward. the front, giving the impression that people are watching. This can cause eye problems and even threaten sight. I therefore strongly advise to see the ophthalmologist. Treatment with Graves’ radioactive iodine is less likely to improve eye disease than surgery.
Many people with hyperthyroidism, whatever the cause, have a lot of energy, and when the level of thyroid hormone in the blood is reduced to normal, they may feel tired or exhausted until the body gets used to functioning normally again. Metoprolol slows the heart rate and methimazole prevents the formation of thyroid hormones. Most experts have their patients on methimazole for one to two years, as many cases of Graves’ disease will recover during this time. Unfortunately, not all do this, so patients have the option of continuing on long-term drug treatment or receiving definitive treatment, ie surgery or radioactive iodine.
You’ve been dealing with it for a year and a half; if you want a definitive treatment now, it is only reasonable that you discuss it with your endocrinologist. Although with radioactive iodine therapy and surgery we try to get the right amount of thyroid tissue, many people will still need to take thyroid replacement hormone.
Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can email questions to [email protected] cornell.edu or mail to 628 Virginia Dr., Orlando, FL 32803.