Managing Hyperthyroidism: Medication Choices and Surgical Considerations

Methimazole and New Mazole are both medications used to treat hyperthyroidism. Methimazole is a thionamide that inhibits the synthesis of thyroid hormones, while New Mazole is a newer formulation that may have similar effects. It is important

Dear Dr.
Yang,
I hope this message finds you well.
My mother was diagnosed with hyperthyroidism this year.
Initially, it seemed that this condition could be well-managed with medication, but unfortunately, it was discovered too late (almost eight to nine years).
We had previously thought it was a congenital heart issue, which delayed her seeking medical attention.

My mother had been seeing a doctor at a hospital in the southern part of Taiwan, where she was prescribed Procil and Methimazole.
They decided on medication and planned for surgery at a later date.
However, out of concern for my mother, I sought a second opinion from a doctor in the north, who completely contradicted the previous opinions and claimed that the medications prescribed by the earlier doctors were incorrect.
He prescribed her three new medications: Procile, Trental SR, and New Mazole.
I found some information regarding New Mazole at this link: http://tw.myblog.yahoo.com/webpharmacy/article?mid=26&prev=27&next=25, which mentions that "10-12 days before surgery to remove the thyroid, this medication must be discontinued and replaced with iodine preparations to ensure the gland is firm for surgery." Since my mother still wishes to undergo surgery to remove part of her thyroid to prevent further complications, she is unsure whether she should continue taking the medication prescribed by this new doctor, as he did not mention this point.
If my mother is to proceed with surgery, would continuing this medication pose any risks? Currently, her symptoms include shortness of breath while speaking, rapid heartbeat, feeling hot, numbness in her hands and feet, and hair loss.
Her lab results are as follows: FIT: 3.8, ATR: 14.58, TSH: 0.06.
As a concerned daughter, I kindly ask for your advice on this matter.
Thank you very much.

Wang Xiaojie, 20~29 year old female. Ask Date: 2009/11/24

Dr. Yang Hongzhi reply Internal Medicine

The cited option is a choice; however, the use of iodine preparations before surgery is not widely adopted in Taiwan, and generally, the original antithyroid medications continue to be used.

Reply Date: 2009/11/24

More Info

Managing hyperthyroidism can be a complex process, especially when considering medication choices and surgical options. Your mother's situation, where she has been diagnosed with hyperthyroidism and is experiencing symptoms such as rapid heartbeat, heat intolerance, and hair loss, indicates that her thyroid hormone levels are elevated. The lab results you provided, including a TSH (Thyroid Stimulating Hormone) level of 0.06, suggest that her thyroid is overactive, which is consistent with hyperthyroidism.

Medication Choices
The medications your mother has been prescribed, including propylthiouracil (PTU) and methimazole, are antithyroid drugs that work by inhibiting the production of thyroid hormones. These medications can effectively control hyperthyroidism and help alleviate symptoms. However, it is crucial to follow the prescribed regimen closely and monitor for any side effects, such as liver dysfunction or agranulocytosis (a decrease in white blood cells), which can occur with these medications.

The new medications mentioned, such as Trental SR and New Mazole, should be discussed with her healthcare provider. It is essential to clarify the purpose of these medications and whether they are appropriate for her condition. The information you found regarding stopping methimazole or other antithyroid medications 10-12 days before surgery and switching to iodine preparations is standard practice. This approach helps to reduce the vascularity of the thyroid gland, making the surgical procedure safer and more manageable.

Surgical Considerations
If your mother is considering surgery to remove part of her thyroid gland, it is vital to have a thorough discussion with her endocrinologist or surgeon. The decision to proceed with surgery often depends on several factors, including the severity of hyperthyroidism, the size of the goiter (if present), and any potential complications from prolonged hyperthyroidism.

Before surgery, it is typically recommended to achieve a euthyroid state (normal thyroid hormone levels) to minimize surgical risks. This is where the use of antithyroid medications becomes crucial. If your mother is still taking the medications, it is essential to communicate with her healthcare provider about the timing of her surgery and the management of her medications leading up to the procedure.

Recommendations
1. Consult Her Doctor: It is imperative that your mother discusses her current medication regimen with her healthcare provider, especially regarding the new medications prescribed. The doctor can provide guidance on whether she should continue taking these medications or switch to iodine preparations before surgery.

2. Monitor Symptoms: Keep a close eye on her symptoms. If they worsen or if she experiences any new symptoms, such as increased heart rate or severe anxiety, she should seek medical attention promptly.

3. Prepare for Surgery: If surgery is the chosen path, ensure that all preoperative instructions are followed, including any necessary adjustments to her medication. This preparation is crucial for a successful outcome.

4. Emotional Support: As a daughter, your concern for your mother's health is understandable. Providing emotional support and encouraging her to communicate openly with her healthcare team can help alleviate some of the stress associated with her condition and treatment.

In conclusion, managing hyperthyroidism involves a careful balance of medication management and surgical considerations. Open communication with healthcare providers is essential to ensure that your mother receives the best possible care tailored to her specific needs.

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