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Radioactive Iodine vs. Thyroid Surgery: Comparing The Benefits and Risks

Published January 14 2013

Obviously the goal of this website is to encourage people with thyroid and autoimmune thyroid conditions to consider natural treatment methods.  But there are times when conventional medical treatment is necessary.  While I’m not opposed to people with hyperthyroidism and Graves’ Disease taking antithyroid medication and/or beta blockers to help manage the symptoms, the ultimate goal is to restore the person’s health back to normal and avoid radioactive iodine treatment or thyroid surgery.  But there are times when restoring one’s thyroid health isn’t possible, and so the purpose of this article is to look at both the benefits and risks of radioactive iodine treatment and thyroid surgery.

To be honest, I really don’t like to use the word “benefits” when mentioning these two treatment options, as while conventional treatment methods are sometimes necessary, there really isn’t a benefit to obliterating one’s thyroid gland or having it surgically removed.  So before I compare these two treatment methods, I first want to begin by briefly discussing when it’s necessary to choose one of these two treatment options.  In other words, when should someone stop following a natural treatment protocol and/or stop taking the prescription medication in order to receive RAI or a thyroidectomy?

With regards to taking antithyroid medication such as Methimazole or PTU, most endocrinologists won’t let their patients take these drugs for longer than two years, although there are exceptions to this.  If someone takes the medication and then goes into remission, some endocrinologists will put their patients on a very small “maintenance” dosage of the medication.  But if someone has been taking the prescription drugs for a couple of years and still has labs that are out of range (low TSH, high T3 and T4, etc.) and hyperthyroid symptoms, then most will recommend RAI or thyroid surgery.

Three Situations When RAI or Thyroid Surgery Might Be Warranted

There are three main situations when a person will need to choose one of these two conventional treatment methods.  The first situation includes certain conditions, such as thyroid cancer.  In this case following a natural treatment protocol might not be the best option.  With that being said there are natural healthcare professionals who focus on curing cancer, so while I personally don’t have protocols I recommend for thyroid cancer, there might be other healthcare professionals who do.  I don’t know of any holistic doctors who specifically focuses on thyroid cancer, and so those looking for a natural treatment solution will probably have to contact someone who deals with different types of cancers.  But in any case, thyroid cancer is one of those conditions in which conventional medical treatment very well might be necessary.

A second situation involves the person who is allergic to the different types of antithyroid medication (Methimazole, PTU), and has severe hyperthyroid symptoms that are unable to be managed by herbs such as Bugleweed and Motherwort.  Since it takes time for a natural treatment protocol to “kick in”, then a person in this situation might need to consider RAI or a thyroidectomy. This case is rare, and even in these situations the person might want to consider a treatment method such as low dose naltrexone.  Plus, keep in mind that radioactive iodine doesn’t work immediately, as it usually will take at least a few weeks, if not longer, before the hyperthyroid symptoms begin to subside.  And sometimes a second dosage of RAI is required.

A third situation involves the person who has followed a natural treatment protocol and has failed to restore their health back to normal.  However, before resorting to RAI or thyroid surgery, there are few things I need to mention.  First of all, you of course should give the natural treatment protocol a fair try before deciding that it doesn’t work.  For example, if you follow a protocol for one or two months and you don’t see any results, this doesn’t mean you should give up.  Sometimes the natural protocol will need to be modified, and there are times when you might want to get a second opinion from a different natural healthcare professional.  Plus of course it’s important to actually follow the recommendations given to you, which is common sense, but there are many people who only follow some of the recommendations, and then wonder why they don’t receive optimal results.  While perfection usually isn’t necessary when following such a protocol, it is very important to be strict.

Now that you know some of the situations when receiving radioactive iodine treatment and thyroid surgery are necessary, let’s go ahead and discuss some of the “benefits” and risks of each treatment procedure, beginning with RAI.

Benefits of Radioactive Iodine Treatment: If you have been visiting my website for awhile, then you realize that I’m not a big fan of radioactive iodine, and so it admittedly will be difficult to prevent my biases from getting in the way here.  But as much as I don’t like radioactive iodine, it can help to eliminate the hyperthyroid symptoms in many people.  Plus when all goes well the hypothyroid symptoms that are likely to develop can be managed well by taking thyroid hormone.  In addition, unlike surgery, no cutting is involved, as RAI can be taken orally.  So the treatment procedure itself is painless, and you aren’t subjected to the risks of surgery, which of course I’ll describe shortly.

Risks of Radioactive Iodine Treatment. Okay, where should I start?  How about the fact that you are putting something into your body that has radiation?  You may not think this is too big of a deal, as this also happens when you get an x-ray.  However, when you get one or more x-rays you aren’t given special instructions which involves flushing the toilet multiple times after going to the bathroom, not being intimate with your spouse, and in some countries they still quarantine people for a few days who receive RAI.  So while I’m not suggesting that receiving radioactive iodine treatment will lead to cancer or other health issues (although this can’t be ruled out), one still can’t dismiss the potential (and unknown) effects this treatment will have on your body.

In addition to the radiation exposure, the goal of radioactive iodine treatment is to make you hypothyroid.  And while many people just take thyroid hormone and live happily ever after, for some people it isn’t this simple.  Some people don’t do well on either synthetic or natural thyroid hormone, even after the dosages have been modified multiple times.  In addition, I have received emails from some people who received RAI who experienced other symptoms that aren’t typical of hypothyroidism.  Whether these symptoms are the result of the radiation I honestly don’t know, but it’s rare that I get the same complaint from someone who has received a thyroidectomy.  So another downside is that the person might actually feel worse after getting RAI, and most endocrinologists don’t know what to do when this happens, other than trying to change the dosage of thyroid hormone, or just telling the person to live with the symptoms.

Finally, radioactive iodine treatment does nothing for the actual cause of the condition.  So for example, Graves’ Disease is an autoimmune condition in which TSI antibodies attack the TSH receptors and cause excess secretion of thyroid hormone.  Something is triggering the autoimmune response, as it could be a problem with your digestive system (i.e. leaky gut), your adrenals, a mineral deficiency, a hormone imbalance, or another factor.  Either way, receiving RAI will obliterate the thyroid gland, thus helping with the excessive secretion of thyroid hormone.  But it won’t do anything to stop the autoimmune response, won’t correct compromised adrenal glands, a leaky gut, address mineral deficiencies, etc.  Perhaps this is one of the reasons why many people who receive RAI don’t do well, even when taking thyroid hormone.  In these cases the thyroid hormone they’re taking might be helping, but perhaps these other compromised areas are causing or contributing to their symptoms.

Benefits of Receiving a Thyroidectomy. The main “benefit” of receiving a thyroidectomy in someone with a hyperthyroid condition is that you no longer have to worry about the thyroid gland secreting an excessive amount of thyroid hormone.  And unlike RAI, thyroid surgery doesn’t involve any radiation, and a second thyroid surgery is usually not required for those who receive a complete thyroidectomy.  I mention this because some people will need multiple treatments with RAI, whereas when someone receives a complete thyroidectomy there is just about no doubt that it will cure the hyperthyroid symptoms, since there is no thyroid gland to produce any thyroid hormone.  While no surgery is completely safe, most people who receive thyroid surgery will do fine, and this is especially true if they choose a surgeon with a good deal of experience.

While most surgeons will recommend a complete thyroidectomy, sometimes a partial thyroidectomy is an option.  Although some people who have their thyroid gland partially removed will still need to take thyroid hormone daily for the rest of their life, some people won’t need to take thyroid hormone.  So this is an option to consider, especially if someone has a nodule on one side of the thyroid gland that is causing or contributing to the hyperthyroid condition.

Risks of Receiving a Thyroidectomy. As is the case with any surgery, there are risks associated with surgery of the thyroid gland.  There is the risk of damage to some of the surrounding structures, such as the laryngeal nerve, and the parathyroid glands.  Of course a definite consequence of a complete thyroidectomy is that the person will need to take either synthetic or natural thyroid hormone for the rest of their life.  And as I mentioned earlier, there are some people who just don’t seem to do well when taking thyroid hormone.  At least with radioactive iodine there’s a very small chance that it will result in becoming euthyroid, where the person no longer experiences hyperthyroid symptoms, but also doesn’t experience hypothyroidism.

Just as is the case with RAI, a big disadvantage of a thyroidectomy is that it does absolutely nothing for the underlying condition.  Once again, it is rare for the thyroid gland to be the actual cause of the condition.  So when another area of the body is responsible for the excessive secretion of thyroid hormone, then removing the thyroid gland won’t do anything to correct these other compromised areas of the body.

Which Treatment Option Should You Choose?

Okay, so now that you know both the benefits and risks of RAI and a thyroidectomy, if you happen to be faced with choosing one of these two treatment options, then which one should you choose?  I obviously can’t make this decision for you.  Although I hope my Graves’ Disease condition will continue to stay in remission for the rest of my days, if I absolutely had to choose between these two treatment options, I probably would choose thyroid surgery.  Of course I realize it’s easy for me to say this when I’m not in this situation, and perhaps I would choose RAI, although I don’t think I would.

With that being said, if I did choose a thyroidectomy I would make sure to find a surgeon who performed at least 500 such surgeries, even if it meant driving to another city or state.  But I understand that this isn’t an easy decision to make, and so when someone sends me an email or posts a comment on my facebook page telling me that they have received radioactive iodine treatment, I never criticize them for this decision.  After all, while some people regret their decision to receive RAI, others feel it was one of the best decisions they ever made.

In summary, while my goal is to try to restore people’s health naturally so they don’t need to receive RAI or thyroid surgery, there of course are times when these conventional medical treatment methods are necessary.  And I hope those people who need to choose between radioactive iodine and thyroid surgery will find this information to be helpful in making their decision.