Hyperthyroid? How to Avoid Radioactive Iodine

Mary Shoman Interviews Dr. Richard Shames

Intro: I recently interviewed Dr. Richard Shames regarding his current thinking about one important issue related to hyperthyroidism. Dr. Shames …(bio)

MS: After 30 years of practice, what's still your biggest surprise?

RLS: 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. 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.

MS: What's your best guess on why endocrinologists so often push for RAI ablation right away?

RLS: 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.

MS: So if the patients are up against all that, what can you tell them would be better to do at this early point in their journey?

RLS: Whether it's my own patient in front of me or a second opinion coaching person 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 - whether you are a man or woman - is to be short, sweet, and logical.

This means saying, perhaps over and over, that you are certainly willing to do the “right thing” (RAI), BUT right now you just want to try Tapezole or PTU first.

MS: Should the informed health consumer try to explain to the doctor why this choice is being made?

RLS: No. It is not logical at this point to try to educate a harried endocrine doctor about the possible benefits of using acupuncture, homeopathy, specific anti-thyroid supplements, better overall nutrition, mind-body techniques, and other useful alternative therapies. No, keep all that to yourself for now. Outwardly, simply request pharmacy prescriptions for beta-blockers (Inderal or Temormin) and the anti-thyroid medications (PTU and Tapezole).

MS: You know, Dr. Shames, I hear that people have tried asking for this medical approach and the doctors did not cooperate.

RLS: Ah, but Mary, did they ask using the magic words.

MS: Now we're curious. What might those be?

RLS: Here's the script of exactly what you should say: “Doc, 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 Tapezole and Inderal, and see how I respond.” Remember, when saying this, be thoughtful and definite. Look him or her right in the eye.

MS: What else should consumers do to be prepared to lessen the doctor's resistance?

RLS: It might be helpful 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 Tapezole or PTU. The pros and cons of this decision are known to me. I agree to hold Dr. _________ and his practice setting harmless regarding any adverse outcome of trying the conservative therapy first, before moving on to the more definitive procedure.]

MS: This sounds good. What should we do if the doctor asks where we got this wording?

RLS: Just tell the doctor that your friend did this and was very successful, and you wanted to try.

Keep in mind that you are not asking for the moon here. This is a reasonable request, medically speaking, and it should be honored.

MS: Now tell us how you see this optimally proceeding.

RLS: Sure. What you want is the time and tools to best initiate a successful, long-term program.  This means having your doctor become a supportive physician who “postpones” the Iodine-131, writes prescriptions for you when necessary, monitors your progress with history, physical exam, blood testing.  Meanwhile, in addition to using low dose Tapezole and possible beta blockers as needed, you can be pursuing on your own a well-chosen mix of alternative therapies.  After a short while you may no longer need the beta-blockers for comfort. You may, before long, drop any sleeping medicines.  As your alternative program helps you to improve, your program allows your Tapezole to be gradually reduced and eventually eliminated. Now you are doing just the alternatives.

MS: I see. As the patient feels better and as the tests improve, the monitoring doctor can feel comfortable continuing the conservative treatment. This sure seems like a win-win. Thank you Dr. Shames, this will be very supportive to many of our readers. Perhaps in a future interview you could outline for us your best advise for exactly what is involved in a comprehensive, multifaceted natural program to improve hyperthyroidism.

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The Canary Club is an educational advisory group with a team of medical advisors headed by Richard Shames, M.D.