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What are the treatment options for Graves Toxicosis?

Q: This is regarding my daughter who is 24 years old. She is having Thyroid related medical problem which was detected 8 years ago. She was put on medication after detailed tests. This problem was identified as Graves toxicosis. Since then she has been on medication as per details given below. However, by the time medication started, she had already lost 4-5 kgs of weight and developed a bulging in her right eye. As already eight years have passed, and her situation has not stabilised, I am rather concerned and would like to seek your opinion regarding a) medication b) any alternative treatment c) chances of full recovery d) any long time effects of the present medication. e) any separate treatment for the bulging eye. So far, we have been giving medicine Neomercazole (2 to 6 tablets a day / Propylthiouracil PTU) only for the Thyroid.

A:a) Medication: many experts, especially in the United States, recommend that Graves should be treated right at the onset with radioiodine ablation, even in young children. Certainly after more than 3 years of medical therapy, your daughter needs either radioiodine ablation or surgery for definitive treatment. b) any alternative treatment: as above c) chances of full recovery: basically the purpose of this is to convert hyperthyroidism into hypothyroidism, which is simple and less toxic to treat. d) any long term effects of the present medication: Persistent, poorly controlled hyperthyroidism has been shown to increase the risk of osteoporosis, and perhaps also heart disease. Very rarely, anti-thyroid drugs are associated with bone marrow depression. e) Any separate treatment for the bulging eye: the course of thyroid function does not always parallel the eye status, which requires independent, sometimes surgical, treatment by an ophthalmologist. You need to be followed up by a good endocrinologist, who will help control hyperthyroidism, and coordinate the rest of her care.

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