Is It Safe To Take Methimazole For Grave's Disease?

Posted on Wed, 27 May 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Wed, 27 May 2015 Answered on

Tue, 23 Jun 2015 Last reviewed on

Question : I have just been dianoosied with Graves Disease. The endo put me on methimazole as I am an occasual smoker and could not do the iodine pill. I am reading so many side effects and possible white blood cell isssues that I am afraid to take this. Can I get an opinion please?
Also, how often should I have my blood count checked to make sure I don`t end up in a hospital from a low blood count? He said 1 in 300 people end up in the hospital from this medication.Is that true ? Thanks You

Answered by Dr. Ajish TP (20 minutes later)

Brief Answer:
Risk not that high

Detailed Answer:
Hi,

Welcome to HCM. I have gone through the question and understand your concerns.

There are only 3 options for Graves' disease

1. Medications like Methimazole
2. Radio iodine treatment
3. Surgery

Methimazole has got 2 serious side effects - liver problem ( increased liver enzymes) and agranulocytosis ( low number or neutrophils)

Incidence of liver problems will be around 1 in 500 and agranulocytosis is around 1 in 1000. We rarely get a case of agranulocytosis once in 3-4 years in our practice. It usually recovers with stopping medications. Changes in liver enzymes is common. We monitor it every 3 months especially if you are high dose like more than 30 mg/ day. We do blood counts if you develop fever and sore throat.

Radio iodine is a safe option if you don't have thyroid eye disease - bulging if eyes. Smoking can worsen thyroid eye disease. Bu smoking won't cause issues for radio iodine treatment.

Hope I have answered your questions. If you have any further queries I will be happy to help you

Regards,

Dr Ajish TP [MD,DM]
Consultant Endocrinologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajish TP (26 minutes later)

Thank You. Last question.How often should I get blood work while on this medication to see if I am having liver damage or low blood cells ?

Answered by Dr. Ajish TP (17 minutes later)

Brief Answer:
Depends on individual case

Detailed Answer:
Hi,

Welcome back.

We do a complete blood count and liver function test before starting medications to see the baseline values. We repeat blood counts only when you develop sore throat or fever. Routine monitoring is not needed when you don't have any symptoms.

Liver function is repeated every 3-6 months if your dose is above 30 mg/ day or if you have jaundice.

Regards
Dr Ajish TP

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar