I am was having tiredness, anxiety ,bulging eyes, uneasiness since months. Doctor diagnosed it as hyperthyroidism. Thyroid levels are- t3- 181.52 ng/dl t4- 13.27 ug/dl ultra tsh- 0.003 uiu/ml free t3- 7.45 pg/ml free t4- 2.63 ng/dl anti tpo- 202.6 iu/ml. Thyroid sonography shows cystic multinodular goitre. Maximum size of cyst is of 5 mm. please help. Doc has prescribed me carbimazole 10 mg and ciplar la 40 mg. And combibest. So can it cured completely? please help. And how to fix the bulging eyes?

Dr. Prabhakar Laxman JatharEndocrinologist50yrs exp

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lybrate-user ji, thanks for the query. I have gone through the details given. Hyperthyroidism is treated with carbimazole or other anti-thyroid drugs. Usually these drugs are given for a period of 18 to 24 months. In quite a few cases thyroid function returns to normal during this period or even earlier. When that happens, anti-thyroid drugs (carbimazole) are discontinued. Again in quite a few patients there is no further hyperthyroidism seen. However, if symptoms return or if again tsh goes low and t4 becomes high, then some times carbimazole can be repeated or other measures are under taken like using radio active iodine (rai), which effectively stops thyroxine secretion and later levothyroxine supplement is used for life. Some times (if there are bigger nodules or any other pathology is involved) surgical approach is taken, which is very rare. Drugs like propranolol are used to control excess heart rate and palpitation. As regards the ophthalmic symptoms with control of hyperthyroidism there is considerable relief from those. There is a need to keep a watch on the size of the nodules as above 1 cm size is considered bad. So now if your tsh has returned to normal that is around 2 to 3 or up to 4 mu/l, then carbimazole can be stopped. Then you have to again test for any increase in t4 and reduction of tsh over next 3 to 4 months. If you have any questions please do come back. Thanks.  

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