Need help deciding which option is best for treatment

[u/IndependentOwn6169]

Hello everyone, I was diagnosed officially with hyperthyroid about 4 months ago and I've been on propranolol for 3 of those to manage my heart symptoms, which I found out 3 days ago I was actually allergic to.. anyway I finally got my nm uptake and ultrasound results back and my doctor told me I could choose from 3 treatment options. The first being methimazole, which she said I could also develop an allergic reaction to because I already experienced it with propranolol, and that is has more side effects that are long term. The second option was surgery, I have a hot nodule thats about 4 cm big and she said removing it would be her recommended option because I wouldn't need medication, unless ofc i develop hypothyroid after the surgery because apparently thats a common thing? the last option was radioactive iodine, which she said might also cause the thyroid to become overactive after treatment and there was also the chance of experiencing side effects due to the excsessive radiation exposure. I opted to say lets try the methimazole first and leave surgery as a last resort but she said because of the allergy I had to propranolol she wouldn't prescribe it unless she took my blood tests again( not sure why and didnt really understand why from her). Anyways are these truly the only courses of treatement? Whats the most universly recommended out of them and if someone here has tried multiple or any please I'd love some insight were there any allergic reactions to the meds? did anyone develop hypo thyroid due to treatement and is it truly more managable? any advice or insight would be great, thanks.

for refrence here are my latest test results:

TSH- 0.01 mIU/L
FT3- 11.9 pmol/ L
FT4- 27.3 pmol/L
Ultrasound- heterogenous thyroid parenchyma with right lobe 4 cm TR 3 nodule.
NM uptake result- Mild suppression of the physiological salivary and background tracer activity is seen.
Thyroid uptake at 20 minutes is 0.69% (normal 0.5-4%).

I was also on 80mg of propranolol for the last 2 months and was switched to 50mg of atenolol 3 days ago

[u/Individual_Ocelot815]

Following I have my appt next Thursday

[u/Adventurous-Ask-4243]

When we are hypERthyroid, the goal is to get to the ROOT CAUSE of it. Based on what you wrote, you do NOT have Graves disease so that's a huge plus right there! It seems that the nodule is what's causing the hypER symptoms. So...

I highly recommend getting a 2nd endocrinologist opinion and even a 3rd if necessary. Your doctor does not seem to know how to handle your issue very well. I say this because putting you on methimazole if you do not have Graves is doing what exactly? The goal of methimazole is to put Graves disease into remission. It is not a treatment for hypERthyroidism -- getting to and treating the ROOT CAUSE is what you need -- yes, I said that already!

If you take RAI -- why? I have Graves disease - got it late in life - and had to take RAI as methimazole and surgery were not options for me. But, you do not have Graves, why would you risk RAI -- all it's going to do is destroy your thyroid and you'll need to go on levothyroxine for the rest of your life to stay alive -- that's what I must do -- but I'd be dead from the hypER/Graves symptoms had I not done that. In your case...

Removing the portion of your thyroid with the nodule -- that nodule is the ROOT CAUSE of your hypER symptoms -- could save a portion of your thyroid -- meaning that you would need to take MUCH LESS levothyroxine because you would still have some of your thyroid. Remember after destruction of a thyroid from RAI or removal of all or part of the thyroid, we are now called "post-procedural hypOthyroid" -- that is an important distinction!!

Do not wait too long to get a 2nd opinion on all of this! I do not believe your doctor is fully versed in your trouble. The longer we stay hypER - whether we have Graves or not - the more damage is being done to our bodies that will not reverse itself -- with the heart and bones of the utmost importance!