Can Hyperthyroid Patients Avoid Radioactive Iodine (RAI)

I had a chance to chat briefly with Dr. Richard Shames regarding his thoughts about thyroid patients faced with radioactive iodine (RAI) treatment for their Graves' disease/hyperthyroidism. Dr. Shames is the co-author of several books on thyroid disease -- including ThyroidPower and Fat, Fuzzy and Frazzled -- and contributed his "Shames Natural Antithyroid Protocol" to my book Living Well With Graves' Disease and Hyperthyroidism.

In the US, many patients who are hyperthyroid -- including those with even mild hyperthyroidism -- are immediately offered radioactive iodine treatment. But, says Dr. Shames, for some who are not in an acute stage of hyperthyroidism, RAI may be premature.

"It's still somewhat of a shock to me how many hyperthyroid patients are told that their only real option is RAI and they must do it right away, to be followed by being on Synthroid forever after," says Dr. Shames. "This is disturbing to me because I've seen so many people do really well with one or another of the wide range of alternatives to this standard procedure."
I asked him why he thinks endocrinologists so often push for RAI ablation right away? Says Dr. Shames:
A diplomatic answer might be that they sincerely feel that other choices have yet to be proven as safe and effective. My personal hunch is that many are simply following this nationwide "standard of care" that would best protect them from future hassles or even malpractice claims. But also RAI is quicker, easier, and much more cost-effective (for the doctor). Medical doctors can charge insurance companies much more for procedures than for educational office visits or writing prescriptions. Also, in today's busy endocrinology practice, it would take an inordinate amount of time to properly educate patients about all their options, and to help each patient decide which might be right for them.
Given the shortage of endocrinologists, and the brief amount of time a patient may have during an appointment, (sometimes as little as five minutes), I wondered how patients can get their doctors to stop and consider alternatives, versus the standard "rush to RAI." According to Dr. Shames:
Whether it's my patient in front of me or I'm coaching someone on the phone, I tell them here's a way that you can avoid or postpone RAI while getting the help you need from your doctor. Remember that endocrinologists as a group are heavily overburdened, often with very ill diabetes patients. Thus, they are generally very busy, straightforward, and have low tolerance for what they consider "nonsense." Therefore, your job is to be short, sweet, and logical. This means saying, perhaps over and over, that you are certainly willing to do the "right thing" (which in their minds is RAI), BUT right now you just want to try the antithyroid drugs Tapazole or PTU first.
According to Dr. Shames, patients should stay away from trying to educate a busy endocrinologist about the possible benefits of an integrative approach to hyperthyroidism -- combining antithyroid medications with more holistic approaches such as acupuncture, homeopathy, specific anti-thyroid supplements, improved nutrition, mind-body techniques, and other useful alternative therapies.

In fact, Dr. Shames has a script for patients who may wish to pursue an integrative approach, but need to continue working with their endocrinologist. Says Dr. Shames:

You can say: "Doctor, I hear you loud and clear. But before actually doing the radioactive iodine, what I need to do for myself right now is a short course of antithyroid drugs and beta blockers, and see how I respond." Remember, when saying this, be thoughtful and definite. Look him or her right in the eye.

You might also want to have written up ahead of time a note that you present to your doctor. Have it signed, dated, and witnessed, and keep it hidden until needed, if at all. Here's what the note should say:

This note is to certify that I have been well-advised to now initiate treatment of my hyperthyroidism with radioactive iodine. With full knowledge of my own situation, it is my very best decision to first try Tapazole or PTU. The pros and cons of this decision are known to me. I agree to hold Dr. _________ and his/her practice harmless regarding any adverse outcome of trying the conservative therapy first, before moving on to the more definitive procedure.
Ultimately, according to Dr. Shames, you are looking for the time and tools to best initiate a successful, long-term program. And, according to Dr. Shames, this means:
  • Having your doctor become a supportive physician who "postpones" the RAI, writes prescriptions for you when necessary, monitors your progress with history, physical exams, and blood testing.
  • Meanwhile, in addition to using low dose antithyroid drugs and possible beta blockers as needed, you can be pursuing on your own a well-chosen mix of alternative therapies.
  • After time, you may no longer need beta-blockers for comfort.
  • As your alternative program helps you to improve, your program may allow your antithyroid drug dosage to be gradually reduced and eventually eliminated.
  • Some patients are able to maintain normal thyroid status using just the alternatives.
Says Dr. Shames:"As the patient feels better and as the tests improve, the monitoring doctor can feel comfortable continuing the conservative treatment."

Richard Shames, MD graduated Harvard and University of Pennsylvania, did research at the National Institutes of Health with Nobel Prize winner Marshall Nirenberg, and has been in private practice for more than twenty five years. Dr. Shames practices holistic medicine -- with a focus on thyroid, autoimmune and hormonal balance issues. He is in practice in California, and also offers second-opinion telephone coaching services.

Photo © Dr. Richard Shames

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