How long might it take for Tapazole to help my hyperthyroid symptoms?

[milo9282002]

Hello Dr - I was dx'd w/multi-nodular, non-toxic goiter and was hyperthyroid, following an MVA in Dec '10.  Been tested, scanned, uptakes, biopsied (benign), elevated iodine levels.  After two months on antithyroid med and feeling better the Tapazole was d/c'd in late October '11.  In early January '12 I was mildly hyper, TSH was 0.203, I was told to have my thyroid labs repeated in 6 weeks, by my endo who has moved away.  I was more symptomatic, inquired into restarting Tapazole but my dr was concerned I might become hypo.  Within six weeks, in mid Feb., my symptoms were increasing, I called for an appt with the nurse practitioner who manages my care, couldn't get in for 2-3 weeks, haven't seen her yet.  I wanted my labs ordered, I have daily headaches, pounding chest, insomnia, severe fatigue, irritable, anxiety, balance issues, low appetite w/trouble swallowing/regurgitating, abd pain/gas/diarrhea after eating, episodes of flushing on my face/neck/chest & R arm with drenching sweats, pains on the L side of my head, chronic daily burning stomach w/abd pain, painful muscles w/knots & spasms, am diabetic. I had three BP reading in the past five days:  151/117; 161/96; and 160/100 after an episode of R shoulder pain, severe stomach burning/pain and flushing with a drenching sweat and clamminess. I saw a new internal med dr four days ago who ordered my thyroid labs.  Long, incredible story shortened: I learned this afternoon that my TSH is 0.009 and restarted Tapazole 10mg/daily.  I don't recall how long it took to see improvement w/Tapazole the first time but I just want to jump out of my skin and have been walking around for weeks feeling like I am going to pass out or drop dead.  My former endo doesn't think all of my symptoms are due to my thyroid, he has checked some other things but the tests were normal.  Do you think all of these symptoms can be caused by hyperthyroidism and how soon until I might feel a little better?  Thanks much.  ~ Mary

[milo9282002]

Thanks for your reply.  I was given the wrong TSH result, it was .09.  After 3 weeks on Tapazole my TSH is .63 but nothing is better except the headaches aren't as bad daily - insomnia, daily burning stomach, high BP, blood sugar dropping low at times (new), sweating, flushing, shaking, chills, goosebumps, fatigue, trouble swallowing, muscle cramps, anxiety from chest pain, epigastric pain and pressure, bloating after eating.  My new endocrinology appt is on 4/17.  I was thinking of doing the radioactive 'kill' but now am considering surgery instead.  I've been told it's patient preference, what are your thoughts on that?  My first endo told me to go back home and have my thyroid removed but after 5 weeks on the low iodine diet my uptake was high enough for the radioactive iodine but I have to be hyper for that.  Sigh.  Thanks again!  :)

[Mark Lupo, M.D.]

It is hard to know if all symptoms are due to thyroid/nodular goiter.  Patients with toxic (functioning) thyroid nodules can be treated with methimazole, but ultimately we recommend radioactive iodine or surgery in most of these cases. You may want to re-establish with an endocrinologist to discuss these options, but in the meantime pay attention to which symptoms improve as the methimazole (tapazole) normalizes the thyroid hormone levels.