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BANGKOK 20 January 2019 08:17


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Advice with Hyperthyroidism (overactive thyroid) - not sure if hospital are doing the right things?

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My girlfriend was diagnosed with Hyperthyroidism (an overactive thyroid) about a year ago. She had symptoms such as weight loss despite eating a lot, general bad feeling, heart racing, shaking etc.. The doctors at Pharam 9 Hospital (paid for by her workplace private insurance) prescribed her Methimazole to reduce the thyroid function. Since then, her thyroid hormones have only reduced marginally and the doctors have been increasing the dosage. This medicine is causing her quite bad side effects such as weight gain (already +5kg despite being on a diet). She is also experiencing a weak immune system as she keeps getting sick, while before she was never ill, even me sleeping next to her with a full on flu. On top of this, she is losing vision in bright daylight and almost had an accident with her motorbike as a result (I've now taken her keys and switched to a BTS card). She has told the doctor about these symptoms but they keep increasing the dosage of her medicine. 


The reason I'm questioning the professionality of her doctor is because we did a trip to Finland and visited a specialist doctor there. It was just to get a prescription as she forgot her meds to Thailand. During the visit we discussed the problem and he was suprised the doctors had prescribed this medicine and not mentioned surgery as an option, which according to him would be inevitable at some point. I believe Phra Ram 9 hospital is a high quality hospital, however it's also one where they prescribe antibiotics for a common cold, anti-depressants for headaches etc.. most meds we get from there I end up throwing to the bin after googling what they actually are. 


Does anyone here have experience with hyperthyroidism? Can it really be treated with drugs or is surgery / radioactive Iodine (Radioiodine) therapy necessary? 



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No personal experience but a Thai lady friend, 40 years old just went through significant thyroid treatments.  After several years treatment in Thai clinics, she finally went to St. Louis Hosp and was diagnosed with thyroid cancer.  I do not know the exact variety.  She had surgery at St. Louis,  5 days hospital stay.  She then went home for a few weeks before entering another medical facility for specific treatment.  I do not know if it was radiation or chemo or some other type but she was kept in isolation for a week.

Now 6 weeks post final treatment and she is doing very well.  No more fatigue or weight gain.  She will be on certain thyroid meds for the rest of her life, she was told.


Sorry my information is not more specific but writing just to point out excellent and competent diagnosis and treatment at St. Louis Hosp.

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You don't mention what is causing the hyperthyroid condition in your girlfriend, however the most common cause is Grave's disease.


You don't mention the medication she is on, however a drug like Tapazole is a common way to deal with this problem, although much like patients with hypothyroidism she will need to take the drug for her entire life or as long as the hyperthyroid condition exists. (Edit: actually you do say the drug is Methimazole/Tapazole. -- propylthiouracil is listed as the alternative) Regular blood tests are very important for this therapy.


Before considering more invasive procedures like surgery, I would ask the doctor to change her medication and see if she does better on a different drug.


If she is having trouble with the drugs, you can consider radioactive iodine therapy or surgery which actually kills (or removes, in the case of surgery) a part of the thyroid gland to limit the hormones it can produce. The problem here is that the productivity of the gland can actually change over time, and she runs the risk of becoming hypothyroid later and being forced to take supplementary T4 for the rest of her life.


Her doctor should be discussing all these options with her and finding the treatment best suited to her, but I would definitely give the drugs a chance before going to other options. Surgery is not inevitable in my opinion, but it can be the best choice if the other options are not giving satisfactory results. I would get opinions from several medical professionals, but ultimately it is your girlfriend's choice how she wishes to handle this condition.


You can also look into non pharmaceutical remedies such as Moringa, which can help in regulating your thyroid gland, but it is important to do this in conjunction with regular blood tests.






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3 minutes ago, Monomial said:


If she is having trouble with the drugs, you can consider radioactive iodine therapy or surgery which actually kills (or removes, in the case of surgery) a part of the thyroid gland to limit the hormones it can produce.

I believe it was the radioactive iodine therapy that my friend, mentioned in my previous post, had on the second hospitalization.

Glad you mentioned it.

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He said she is on Methimazole which is same thing as Tapazol.


Hyperthyroidism can have several different causes. In some cases there is a rapid cycling of hypo and hyper states. If not done already she needs to have blood test for thyroid antibodies.


Treatment needs to be guided by, among other things, the underlying cause of the hyperthryoidism. Contrary to what you quote the doctor in Finland as saying, surgery is nto usually done unless the hyperthyroidism is connected to a thyroid tumor, or the patient cannot tolerate/does nto respond to more conservative approaches.


That said, it does sound, from the symptoms and problems you report,  like she is not being well managed. The choice of hospital is not important, it is the doctor that matters. I don't know anything about the endocrcinologist(s) at Praram 9.


I would suggest she get all her records, test results etc and consult this  excellent , Harcard-trained thyroid specialist:




If the insurance she has is Social Security then she will have to pay out of pocket for this as it is limited to the hospital where one is registered. If it is private insurance scheme that includes OPD then should  cover it...in which case I suggest switching to Dr.Roassanee's care.


The consultation plus hospital surcharge will run to about 1500 - 2000 baht, that is without lab work or meds. If she has to pay herself then you could try  doing this as a second opinion and having Dr. Rossanee write down her suggestions and then bringing that back to the doctor at Praram 9.

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In October of 2015 I was diagnosed with hyperthyroidism.


The symptoms included an irregular heartbeat which would self regulate itself. Initially, I would have an irregular heartbeat for a day or so and then be ok for a week or so. After a few months of this the progression gradually increased whereby I was having irregular heartbeats for a solid week or so with only a day or so of normality.

Eventually one morning I was reading a book when I had to squint to read the words, feeling distinctly unwell I got up to walk around but found that I had to sit down again otherwise I would have fallen down!

After about 15 minutes I felt ok.

However, I got a friend to take me to the Bangkok hospital in Khon Kaen to get checked out, this was a Sunday so went to emergency, I was booked into ICU for observation and tests.


It was found by blood tests that I had hyperthyroidism.


Initially I was prescribed  tapazole 3 times a day and the same with inderal.


It has taken 2 years of increasingly less dosage of the tablets to bring the thyroid to within the normal range. I was taken off the inderal, (beta blocker), about a year ago, no ill effects.


I attended the hospital every 2 months for blood tests to keep track of it all.


Initially, the readings were: 

Thyroid Stimulating Hormone (TSH)   <0.005  normal range (0.270-4.200)

Triiodothyronine Free (Free T3)               11.16                           (2.00-4.40)

Thyroxine Free             (Free T4)                 3.18                            (0.93-1.7)


I have been tablet free since earlier this month - I will be going for a final blood test in December after being off the tablets for one month.


I have since found out that I have 2 sisters who also had/has hyperthyroidism. Maybe also it is inherently in the genes.


As an aside - My lipids were not too brilliant,  as I found out when in Bkk medical centre having my big ops last year.

LDL was 166 and Glucose hovering around 100 to an extreme of 110.


To control this I adjusted my diet to regulate it,  glucose level consistently  below 100 but LDL not so easy to control

but have had it down to below 130 a couple of times. I find by taking one omega 3 tablet a day seems to improve the LDL.


For ease of following the progression of it all, made a graph so can follow pictorially with notations of amount of tablets being taken and any unusual happenings along the way.


Cost - Thyroid  Function test  (TSH,Free T3,Free T4) -                      1000 baht

            Lipid profile (glu.Chol,Trig,HDL,LDL)-                                         712 baht

with Physicians charges + bits and pieces including medicines generally the total bill has been between 2200-3000 baht.


A big thing is exercise - religiously do 30 minutes a day on the treadmill at a fast walking pace (5.8kph at an incline), sweating a bit at the end of it!


Am 69 and vary between 72kg - 75kg depending on what I do in the afternoons, i.e. strenuous work or not.


Sorry for the ramble


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I had Graves disease some years ago and was put on Tapazole which managed the problem. After a few years which included an unpleasant eye operation (Graves screws up your eye muscles), my doctor decided that my overactive thyroid was never going to settle down so I could either take Tapazole for the rest of my life, or zap the thyroid with radioactive iodine and then supplement with thyroid hormone. I chose the latter and now take daily thyroid hormone pills which are cheap, available over the counter and have no side effects.

It was a long journey; hope your gf resolves her problems.

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