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THE Q & A

Welcome to The Q&A with Elaine Moore. Registered members are invited to ask any question of Elaine Moore on autoimmune diseases, Graves' disease, other thyroid diseases and subconditions, laboratory work, traditional and complementary medicine, triggers and environmental influences, thyroid and immune disorders in pets and animals, and other relevant areas of inquiry.

Each thread represents one question with one answer and will only appear at the time it is answered. Once answered, further replies cannot be made to the same thread since each thread represents only one question. A new thread will need to be started for additional questions.

Questions are answered solely by Elaine Moore, a medical writer and clinical laboratory scientist, MT, CLS, with more than 30 years of experience in immunology. Moore has also authored and edited over a dozen books in the area of health sciences and is an editor for McFarland Publisher's Health Topics Series.


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 8/29/2010 11:50 AM
 
Hi
I have just been diagnosed with being hyperthyroid. Saw the endocrinologist on Friday and he prescribed PTU 100 mg 2x day, lab test on Friday, including liver values, then repeat lab test in 2 months and in 4 monhs, next appt in 4 months. Have not a confirmed diagnosis of Graves yet, Endo Dr. had not all results yet.
For starters I am concerned about the PTU, what I've read so far (after I have seen the Endo) the Methimazole would be the preferred joice regarding safety, effectiveness. My main concern is the rare but serious effects to the liver and low white blood cells. Can you give your opinion please and how do I approach this with the very busy endo Dr. who I only saw for 5 minutes and won't see for another 4 months.
Thanks
Dagmar
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 8/29/2010 5:31 PM
 
 Modified By Elaine  on 8/29/2010 5:34:09 PM

Hi Dagmar,

PTU has been used for more than 70 years, and liver problems are reported to exclusively occur when inappropriately high doses are used especially in children. Your doctor must be aware of the reports but have lots of experience using PTU since he's using a conservative starting dose of 200 mg daily. Many doctors still use the old recommendation of 300 mg, and some doctors prescribe very high doses in excess of 600 mg.

Your doctor has also ordered liver function tests, which is good. I'd personally use the PTU and expect to have your dose reduced as soon as FT4 falls into the reference range regardless of the TSH level. This usually takes 6-8 weeks. After your next labs at 2 months, you should check to see if your dose can be reduced. The usual maintenance dose after 8 weeks is 50-150 mg daily.

Both PTU and MMI can rarely cause agranulocytosis, a decrease in the segmented neutrophilic white blood cells. There used to be no treatment available for this condition if it developed but now colony stimulating factors are given should it occur. Like the liver problems, it primarily occurs when inappropriately high doses are used.

Then again, if you notice anything at all that you don't like about PTU or object to its use, you have a right to ask about using methimazole. A 20 mg mmi dose is equivalent to a 200 mg PTU dose.

Best, Elaine

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TO USERS: Q&A posts are visible to all readers. Users can delete their own threads at any time. Users must provide information which is true and correct to the best of their knowledge as well as provide sources or references to any health / medical information if not taken from personal experience. All users including the moderator must behave at all times with respect and honesty. Advertising and self-promotion is not allowed. The moderator or site administrator has the right to ban users with or without warning for not following the basic rules of this site. All posts by default are not to be considered that of medical professionals unless otherwise indicated. As sole moderator, Moore has no conflicts of interest in the sponsorship of this forum.

 

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