Category Archives: Thyroid

Is my Sore Throat due to Hashimotos

At the end of the last My Story post I was advised by DrG to reduce my intake of medication, so I had stopped taking the natural dessicated thyroid, the T3 and reduced the T4 (oroxine)  from 100 to 75.

The hangover lifted, the feeling that my heart was tumbling ( like a tumble dryer) in my chest went, and after about 4 days of feeling tired I had two days when I felt ‘normal’. Normal is the epitome of Heaven, to a normally healthy person, you have no idea what bliss it can feel like to someone with an illness!

Then I started to feel the swing in the other direction. The black hole returned and dragged me under into sleep after lunch. My eyes remained sore until I slept and I got a pain in the bum. The constipation which I never had before T4 responded to magnesium, but the pain in the bum didn’t go until I started taking T3 again. I returned to 100 oroxine by cutting the 75 in three and cut the 25 cytomel in thirds to take approx 8.

For almost a month I was as near normal as I might expect to be. But life doesn’t let you rest. Our financial situation is bad and the stress of meeting bills and always being late and overdrawn and not quite making them is constant on both of us. Even more so probably on my husband as he is the one earning the most money. But the stress eats at you and insufficient funds means you cut back to basics.

Moeller's cod-liver oil advertisement
Moeller’s cod-liver oil advertisement (Photo credit: Wikipedia)

It means no doctors appointments or tests, and you can’t afford to replace expensive zinc or magnesium, special multi vitamins, colloidal minerals. All these ran out and I am left just taking B vitamins, iron, cheaper magnesium, cod liver oil and vitamin C. My migraines have returned and I have a low grade headache all the time. I need the zinc for that but its $50. The cheaper zinc doesn’t do anything.

Maybe next month…

Is my Sore Throat due to Hashimotos or is it a Reaction to Gluten?

Friday night is takeaway night. Might be pizza, might be Kentucky fried chicken. When you are gluten free, neither is suitable of course. I have assumed I am gluten intolerant, but have had no tests, don’t think its coeliac, but don’t really know either way.

Normally I’d cook something for me, a piece of fish or some eggs. Sometimes if it was Kentucky, I’d strip off the crumbing and just eat the chicken meat, and that was ok. This Friday I spat the dummy and ate 2 pieces of Kentucky crumbs, skin, spices, herbs and all. It was lovely.

On Saturday I woke up with a sore throat and fever and was so tired I slept all day and all night and half of Sunday. I gargled with iodine to no effect. I gargled with warm salty water. I sprayed it with the sore throat stuff I buy for the kids sore throats, all to no effect. I took aspirin every 4 hours and that kept the fever in check and gave relief from the soreness.

I was a bit less tired during the week, and helped my husband on a painting job most days. My glands stayed swollen until Wednesday, I had no energy but was not so tired, although an afternoon nap was called for each day. I had a constant dry cough, very little mucus production but prickly in the nose again and sneezing like from allergy, and low fever still. I struggled to take a full breath and when I did I coughed.

Today is Sunday a week later. The sore throat and mild other symptoms are still there and I’m pretty sure the pain is “in” the thyroid, though I feel it in my throat, it would explain why neither salt or the iodine couldn’t take it from the throat.

English: Voltaren
Voltaren

I thought about going to the Hospital or a doctor, but I’ve only just managed to reduce candida to a whisper and antibiotics would be like putting out the fire with gasolene. What else do they have to offer? Aspirin and other NSAIDS which I cannot take like Voltaren (instant sore stomach) . so… Nothing new I don’t know about I think.

I looked up sore throat and Hashimotos on the internet and discovered some great new articles but I am still not sure how to categorise it and whether to seek medical advice . I hate feeling like a hypochondriac!

  • Is this just a viral bug – sore throat, fever etc?
  • Is it just a normal bug that has affected my thyroid, or been different due to having Hashimotos.
  • Is it an allergy like hay fever?
  • Is it because I ate gluten for the first time in a year and antibodies attacked my thyroid in droves ( even though I have never experienced this type of reaction before as a “sore throat”)
  • Is it just a progression of the disease?
  • Is it due to not taking the natural thyroid or from reducing the medication too much?

Several links suggest that the sore throat pain is actually from the thyroid.

Swollen Lymph Nodes & Sore Throat With Hashimotos anecdotal confirmation it is related to thyroid

All this caused by Hashimotos! this was just downright fascinating reading the advice in comments

Overall MD article on Thyroiditis helped by stating use analgesic, anti inflammatory, antibiotics to treat

Treatments for sore throats due to thyroiditis bit easier to read than above and confirms treatment

STTM advice of course contravenes what my doc said – (I know, you can’t follow two masters)

Essential Oil and Sore Throat an advocate for lemongrass oil applied to the thyroid area on throat

Coconut Oil and Sore Throat an advocate for increasing consumption of coconut oil

Well who knows? I guess for now I’ll stay at 100 oroxine and 8 cytomel and continue to take aspirin for the sore throat. It’s been one week since it started and it will probably just go away next week. If not, then we’ll try and find the money for something – zinc maybe, maybe a doctor – not really sure which is the better value! lol!

17th Nov Update
The sore throat isn’t going away. It did get a bit better and then it got suddenly worse and now its getting better again. I now believe its iodine causing it.

I took Lugals when I first started treatment and felt better for it. Four or five months later I read that iodine might not be good for people with Hashimotos so I stopped until I talked to DrR. He felt that continuing would be beneficial but to reduce it to 2 drops.

I get tired of taking supplements. My husband wouldn’t believe that because he doesn’t think they have any effect. I don’t think he even believes I’m sick, I’m walking around after all! I know things start to go haywire when I stop taking stuff, like now. I don’t know for sure which are doing good and which are not.

I believe that zinc, magnesium, iron and vitamin C are essential for me. I believe that B vitamins and probably A, D and E vitamins are also important.

I think selenium and iodine are good but I’m not sure.

I hadn’t been taking iodine and selenium regularly and then I watched Dr Tenpenny’s video on iodine. I started taking 2 drops iodine again with 5 drops selenium like before.

What if this is what has caused my sore throat. At the bottom of the throat there are two round bones, over the right one, I sometimes see a slight swelling. It appears larger when my sore throat gets worse. I wonder if its the start of a goiter. I originally thought goiter is only caused by deficiency of iodine, but too much iodine can also cause goiter.

When I stopped taking iodine daily my sore throat slowly got better, but I didn’t at that time think it had anything to do with iodine. One day I did take my iodine in the morning and with in hours the sore throat was back with a vengeance. I stopped taking it and it is almost gone.

I don’t feel it is a coincidence. I think my thyroid struggles to process the Lugals now. I read that you can paint it on the sole of your foot for a different way to absorb it. For now, I’ll wait and see if the throat actually gets better at all.

I am supposed to have blood tests this month and go see the doc. Don’t think it’s going to happen before Christmas. I guess if the sore throat continues, if its a possible nodule, I can go to the hospital.

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Dr. Sherry Tenpenny talks about Iodine

Dr. Sherry Tenpenny outlines the many disorders that come about because of iodine deficiency IAOMT 2007 L.V. This is a must see, especially for women that have problems with their thyroid or their breasts. Almost 1/3 of the people of the World are iodine deficient. 11% of USA citizens are overtly iodine deficient. 1 in 8 women may get breast cancer.

Why? Maybe because…  We can’t eat salt if we have high blood pressure. We don’t eat eggs because of cholesterol. We don’t eat fish because of mercury. We don’t eat seaweed and minerals in soil are depleted.

This hour long video has many highlights for me as a sufferer of Hashimotos hypothyroidism. I took a few notes of specific times as it went on so I could listen again to what she says about specific topics.

05.00  Jack Kessler on PMT and sore breasts, iodine and breast tissue
11.00  The tip about going around the supermarket not up the aisles
14.00 How much is enough iodine
16.00 How does iodine get into the tissues. Dry eyes, mouth
18.00 TSH and T4 (4 molecules of iodine)
21.00 Iodine and Healing Graves?
23.00 Selenium and Iodine
27.00 Hashimotos
33.00 Graves
35.00 Conclusions
37.00 Breasts
46.00 testing for iodine
52.00 How much over RDA is safe
53.00 Side effects – iodism
57.00 Toxic Metals and selenium

 

 

 

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Legacy From Dr. Lowe

Death of and Legacy of Dr. John Lowe

John Lowe

22/1/1946 – 9/1/2012

http://www.drlowe.com/

I never met Doctor Lowe, nor ever expected to – but I felt I knew him, because he was such an honest writer. When I was first diagnosed as hypothyroid, Dr Lowe’s website on hypothyroidism and fibromyalgia was one of the first complex websites I started my research on and one of only a few that I return to often for further information.

If I had never been able to read his website, I would not understand my disease as well as I do. Nor would I have had the opportunity to experience John Lowe’s personality, his humility and generosity about sharing his immense knowledge and experience via his website’s Q&A section. Patient’s questions and his answers helped me to answer my own tricky questions, and his kindness and even handedness enabled me to trust his answers, more so than any other doctor (or patient) who has written articles about thyroid treatment on his/her website.

So it was with genuine sadness that I read his wife’s email informing us that Dr John Lowe died on the 9th of January 2012 due to complications from a head injury incurred in November 2011. Tammy Lowe was also thoughtful enough to reassure us that Dr Lowe’s website would remain available to patients online. My heart goes out to her as she faces his loss and to Dr Lowes family and friends.

In Memorium of Dr John Lowe

Dr Lowe wrote several memorials for colleagues that are published on his website, and the respect and admiration for these collegues just glows in his writing. As I read these I felt that it is like someone writing in memorium for him, just change the names.

Because Dr Lowe was a doctor who “took hard hits for his brave stance” like Dr Garrison,

On Dr Garrison Dr. Garrison and I didn’t agree on all matters. But our friendship was bound by a love of quality scientific work and the mission of freeing fibromyalgia and hypothyroid patients from the misery imposed on them by the false beliefs of conventional medicine. Dr. Garrison was one of the smartest and most courageous physicians I have ever known.

He took hard hits for his brave stance that we were right: that too little thyroid hormone regulation is the basis of most patients’ fibromyalgia. The hardest hits came from physicians who promoted the pseudo-scientific and quack notion that fibromyalgia is a psychiatric disorder. But he stood his ground and absorbed the political blows.

Dr Lowe also “directly took on conventional medicine” and “risked his personal career for the sake of truth and protecting patients” like Dr Mendelsohn

On Dr Mendelsohn His courage in the face of damaging political opposition in medicine was like that of my old friend Robert S. Mendelsohn, MD. He, too, is now deceased, but he directly took on conventional medicine in the 1980s. In doing so, he was almost single-handedly responsible for the justified contempt today of millions of people for the harm done by conventional medicine. He, like Dr. Garrison, risked his personal career for the sake of truth and protecting patients.

And like his good friend Dr Gedye, Dr John Lowe has had a huge impact on so many people’s lives.

On Dr. John Gedye It has been said that those who’ve left us have but one chance at immortality. That chance lies in what they’ve left behind: our memory of them. The impact of a person’s life, the effect that life had on other people, their experience of the person – this is what remains. We honor John Gedye by remembering, and continuing to remember, how he affected us and why we’ll miss him so much.

I know that thousands of people will honor John Lowe by remembering what he did for us all with his research and his enquiring and logical mind and his courageous refusal to be bullied by “the system”.

Dr John Lowe’s Legacy

The following text is a summary of
http://www.drlowe.com/jcl/biojcl.htm

Dr. Lowe began using myofascial therapy in 1980 under the tutelage of the late chiropractic radiologist and clinician David Ramby, D.C. After studying factors that make myofascial patients treatment resistant, he began tenaciously studying biochemical abnormalities. Dr. Lowe found that hypothyroid fibromyalgia patients usually recover from their fibromyalgia symptoms and also found that most fibromyalgia patients who aren’t hypothyroid also improve or recover when treated with fairly high dosages of plain T3.

In 1995, one of Dr. Lowe’s patients who had recovered from her fibromyalgia symptoms through his metabolic approach convinced him to established the Fibromyalgia Research Foundation (FRF). The three purposes of this 501(c)(3) nonprofit organization are to:

  1. support scientific studies of the metabolic treatment of fibromyalgia patients;
  2. determine the underlying molecular mechanisms of fibromyalgia; and
  3. educate fibromyalgia patients, clinicians,  researchers, and the general public about the findings of FRF-sponsored research.

Dr. Lowe has remained vocal about what his research group determined to be the ultimate creator of what we call fibromyalgia. That is T4 replacement therapy.

This therapy is so mistakenly conceived and clinically ineffective that since the early 1970s, when it was first imposed on thyroid patients, a range of mysterious new diseases have been reported. Published research shows that the plausible mechanism for most of these “new” conditions is too little thyroid hormone regulation.

In 2006, Dr. Lowe published the first two studies that showed fibromyalgia patients had resting metabolic rates about 30% below normal patients and had significantly lower basal body temperatures than those of healthy controls.

What Dr Lowe’s Research Has Really Shown:

A Clarification for Our Critics and Supporters

by Dr. John C. Lowe & Dr. Gina Honeyman-Lowe

  • Of the fibromyalgia patients we’ve tested, roughly 12% have had lab test results consistent with primary hypothyroidism.
  • Of the patients we’ve tested, about 44% have had test results consistent with central hypothyroidism.
  • The remaining 44% of fibromyalgia patients we’ve tested have  had lab results consistent with normal interaction of the pituitary and thyroid glands. Of this roughly 44% of patients, we have incontrovertible laboratory proof that about 75% have partial cellular resistance to thyroid hormone.
  • Together, lab test and treatment results of fibromyalgia patients we’ve studied strongly point to a conclusion: Around 90% of our patients have had thyroid disease of one form or another.
  • Most of the 90% of patients with evidence of thyroid disease also have one or more other metabolism-impairing factors impinging on them. These other factors compound the effects of hypothyroidism and/or thyroid hormone resistance in causing the patients’ fibromyalgia symptoms. The most common of these other factors are
    1. poor diet (most commonly one that causes blood sugar and cellular energy abnormalities),
    2. nutritional deficiencies,
    3. poor physical fitness,
    4. adrenal and sex hormone problems, and
    5. the use of metabolism-impeding medications.

Dr John Lowe has been an ardent advocate for alternate treatment to the standard hypothyroid treatment of T4 – the “one size fits all” approach of most GPs and endocrinologists. His three websites, his book The Metabolic Treatment of Fibromyalgia and his Curriculum Vitae are the legacy he has left in an effort to educate those doctors who are still “causing harm” instead of healing, due to the misinformation of their outdated training or the pressure of “big pharma”.

Thank you Dr Lowe and rest in peace.

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Haskell Hashimoto Videos

Dr Alexander Haskell’s Videos
on Treating Hashimoto’s Thyroiditis

I haven’t had a chance to watch these videos yet but there are good comments about them in various threads I have read so I have embedded them here so I can easily watch them

Hashimoto Thyreoidits Histologie
Histology

( without being distracted by other you tube videos such as the pretty histology videos and so many other doctors with advice … )  there is just never enough time…

Please view updated Hashimotos videos on Dr Haskells site.
Hope for Hashimotos

Video 1

[iframe_loader src=”http://www.youtube-nocookie.com/embed/3kKmZIjFS9I” height=”315″ ]

Video 2

[iframe_loader src=”http://www.youtube-nocookie.com/embed/uhBONfypTEE” height=”315″ ]

Video 3

[iframe_loader src=”http://www.youtube-nocookie.com/embed/CbCjrMOtFiE” height=”315″ ]

Video 4

[iframe_loader src=”http://www.youtube-nocookie.com/embed/dps36ENqZME” height=”315″ ]

Video 5

[iframe_loader src=”http://www.youtube-nocookie.com/embed/ZewjVFSjsDU” height=”315″ ]

Video 6

[iframe_loader src=”http://www.youtube-nocookie.com/embed/nWpFZibOST0″ height=”315″ ]

Video 7

[iframe_loader src=”http://www.youtube-nocookie.com/embed/R3Zv9As1K20″ height=”315″ ]

Video 8

[iframe_loader src=”http://www.youtube-nocookie.com/embed/X8-Pn8UYGeQ” height=”315″ ]

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Thyroid Dr Skinner Wins David and Goliath Battle

Thyroid Patient Avocate Dr Gordon Skinner Resumes Normal Practice After Wrongfully Being Accused of Reckless Prescribing

First they ignore you, then they laugh at you, then they fight you,
then you win.”   ~~Mahatma Gandhi

Quote from “What we have learned” STTM

And now for something completely different but absolutely terrific news.

I just read that UK doctor Dr Gordon Skinner has finally been released from his General Medical Council restrictions after 5 years. Is it any wonder doctor’s don’t speak up when those that do are treated in this way.

Why does it take 5 years to work out that thyroid patients are not happy with current medical guidelines on thyroid treatments.

Is it any wonder patients feel they are actually being better treated by natureopaths and “reckless” doctors.

Why don’t legal organisations like this read the forums on the internet? However “subjective” they may be, the sheer volume of complaints must surely be an indication of a discrepency between what is known by doctors and what is known by patients.

Ah well water under the bridge now, but three cheers for Dr Skinner for never giving up on this battle and winning it for all thyroid disorder sufferers as well as for himself.

News Articles

Reckless Mosely Doctor Has Conditions Lifted on His Medical Licence  – After more then five years of restriction, the General Medical Council (GMC) allows Dr Gordon Skinner to resume normal practice.

The Wake You Up Pill – controversial thyroid supplement help tiredness

(Such sensationalist headlines – How about “Effective Thyroid Doctor Wins a David and Goliath Battle About Old School Treatment.”. Or that tacky second headline – how about “Doctor Does His Job Well and Patient Feels Better” Ok, maybe no-one would employ me to write headlines. Who cares, he won!)

Info on Thyroid Treatment Written by Dr Skinner

People Power Will Continue to Work if Patients Sign Skinner’s Thyroid Register

Official transcripts from Dr Skinner’s GMC FTP Hearing and Related Articles

Diagnosis and Management of Hypothyroidism by Dr. G R B Skinner MD, DSc, FRCOG, FRCPath

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3 Treatments For Hypothyroidism

3 Treatments For Hypothyroidism

There is no cure for autoimmune hypothyroidism. A thyroxine replacement medicine will have to be taken for the rest of a person’s life and dosages must be carefully monitored. As there are only three options, you would think there’d be less controversy. Instead every forum thread and article comments thread are long and passionate about which treatment is best and why.

Alternate Opinions About Hypothyroidism Treatments

Some studies have suggested that subclinical hypothyroidism does not need to be treated. There is always the risk of overtreatment and thereby provoking hyperthyroidism. This article discusses the medical viewpoint on subclinical hypothyroidism in detail

The hormone feedback of the thyroid.
Image via Wikipedia

The thyroid also takes time to adjust when being treated, so it may take 6mth to a year before the right treatment stabilises and mitigates your hyperthyroid symptoms consistently.

The treatment of hypothyroidism may be conducted by a doctor, a natureopath or an endocrinologist.

This is the viewpoint of an endocrinologist on dessicated thyroid

I love to read the comments below the articles -they are true picture of what works for people.

Those physicians that are familiar and open minded about the combinations of the three treatments for hypothyroidism are highly sought by those patients who do not respond positively to the medically accepted T4 alone treatment.

Adding T3 to T4 Treatment

Under normal circumstances, the thyroid releases 100-125 nmol of thyroxine (T4) daily and only small amounts of triiodothyronine (T3). The half-life of T4 is approximately 7-10 days. T4, a prohormone, is converted to T3, the active form of thyroid hormone, in the peripheral tissues by 5’-deiodination.

At first, compensatory mechanisms maintain T3 levels. Decreased production of T4 causes an increase in the secretion of TSH by the pituitary gland. TSH stimulates hypertrophy and hyperplasia of the thyroid gland and thyroid T4-5′-deiodinase activity. This, in turn, causes the thyroid to release more T3.

First treatment is to provide T4 known generically as levothyroxine, with brand names including Synthroid, Levoxyl, and Levothroid . It appears however that some patients do not convert the T4 easily to T3 and therefore their symptoms are not eased by taking T4 alone. T3 treatment is more expensive and requires the patient to take it twice or more a day but may be added to the treatment if blood test results are not brought back into range.

Compounded slow-release T3 has been suggested for use in combination with T4. It’s advocates argue it completely mitigates many of the symptoms of hypothyroidism and greatly improves quality of life.

Desiccated  Thyroid

T4 and T3 are synthetic prescription treatments. It is also possible to get desiccated (dried) thyroid. This is a prescription thyroid hormone replacement drug, prepared from the thyroid gland of pigs. Brand names including Nature-throid, Armour Thyroid, and Westhroid.  Desiccated  thyroid has been used safely for over 100 years and until synthetic thyroxine was introduced in the 50s, it was the only thyroid hormone replacement medication. It includes T1 and T2 which are rarely mentioned and are considered irrelevant as a treatment.

Desiccated  thyroid is now considered to be “old school” and a controversial alternative practioner treatment that is rejected by the conventional medical establishment.

However many patients swear by it, having  complete mitigation of their symptoms with no side effects. Some people hate it as it appears to be too strong and tips them into hyper. Others are completely happy with T4 and never try anything else.

 

 

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TSH Levels Hypothyroidism

TSH Levels and Subclinical Hypothyroidism

Early hypothyroidism may display very mild symptoms or have none at all.

Subclinical hypothyroidism occurs when thyrotropin (TSH) levels are elevated but below the limit representing overt hypothyroidism. The levels of the active hormones,  thyroxine (T4) and triiodothyronine (T3) are normal and will be within the laboratory reference ranges.

Symptoms become more readily apparent in clinical (or overt) hypothyroidism.

In primary hypothyroidism, TSH levels are high and T4 and T3 levels are low. TSH usually increases when T4 and T3 levels drop. TSH prompts the thyroid gland to make more hormone.

The only validated test to diagnose primary hypothyroidism, is a blood test to measure thyroid-stimulating hormone (TSH) and free thyroxine (T4). However it is not totally conclusive, as these levels can also be affected by non-thyroidal illnesses.

High levels of TSH indicate that the thyroid is not producing sufficient levels of thyroid hormones (mainly thyroxine (T4) but also triiodothyronine (T3) in smaller amounts). However, measuring just TSH fails to diagnose secondary and tertiary hypothyroidism. So if the TSH is normal and hypothyroidism is still suspected, further blood testing may be required. Misdiagnosis is common in hypothyroidism, with types of thyroid dysfunction failing to be identified immediately by some laboratory tests. Further tests may be conducted such as…

Measure T3, T4

Free triiodothyronine (fT3)
Free levothyroxine (fT4)
Total T3
Total T4

or other things such as…

Free T3 from 24-hour urine catch
Antithyroid antibodies — for evidence of autoimmune diseases that may be damaging the thyroid gland
Serum cholesterol — which may be elevated in hypothyroidism
Prolactin — as a widely available test of pituitary function
Testing for anemia, including ferritin
Basal body temperature

(S)-Thyroxine_Structural_Formulae L-Thyroxine_...
Image via Wikipedia

There is a range of medical opinion on what agreed upon reference points a patient should be treated with thyroxine, the typical treatment for overt hypothyroidism.

Reference ranges have been debated regarding TSH. The lab that did my results in Australia used 0.4–4.0 mIU/L .  As of 2003, the American Association of Clinical Endocrinologists (ACEE) considers 0.3–3.0 mIU/L within normal range. Previously 0.5–5.0 mIU/L was used, and many doctors (as reported by patients in the health forums) do not treat until the range is over 10.

 

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Symptoms of Hypothyroidism

Symptoms of Hypothyroidism

A medical student checking blood pressure usin...
Image via Wikipedia

Hypothyroidism usually develops slowly and early symptoms can be very mild to imperceptible. Many symptoms are at first brushed aside as a normal part of the ageing process. However when such symptoms group together or become more severe, it’s time to make notes about them and go see your doctor and request a blood test.

Signs of hypothyroidism indicate that the body is shutting down and not coping. They include the following symptoms:

Early Signs

Dry, itchy, scaly skin
Thin, brittle fingernails
Dry coarse hair,

Sore eyes, blurred vision
Puffiness around or sunken eyes

Sleep disturbances

Increased sensitivity to cold
Decreased perspiration

Constipation

Slowed speech and movements
Lethargy, apathy, no energy

Depression, broody thoughts
Forgetfulness, impaired memory
Confusion, unable to concentrate

Fatigue, sleepiness

Muscle cramps,
Muscle tension, tightness
Poor muscle tone (hypotonia)
Joint pain

Weight gain and water retention

 

Symptoms more specific to Hashimoto thyroiditis:

Feeling of fullness in the throat

Painless thyroid enlargement

Exhaustion

Neck pain, sore throat, or both

Low-grade fever

Later Signs

Goiter

Elevated serum cholesterol

Anaemia caused by impaired haemoglobin synthesis (decreased EPO), impaired intestinal iron and folate absorption or B12 deficiency from pernicious anemia

Slow speech and a hoarse, breaking voice – deepening of the voice can also be noticed, caused by Reinke’s Edema.

Dry puffy skin, esp of face
Increase in Hair loss
Thinning of the outer third of the eyebrows (sign of Hertoghe)

Abnormal menstrual cycles
Fertility problems

Thyroid-Related Depression
Irritability and mood instability

Dull facial expression
Coarse facial features

Sluggish reflexes
Weakness in the extremities

Bradycardia (slow heart rate – pulse – fewer than sixty beats per minute)

Blood pressure – Decreased systolic blood pressure and increased diastolic blood pressure

Low basal body temperature

Increased need for sleep

Shortness of breath with a shallow and slow respiratory pattern

Less Common Signs

Puffy face, hands and feet
Pericardial effusion (fluid around the heart)
Abdominal distension, ascites
Nonpitting edema (myxedema)
Pitting edema of lower extremities
Hyporeflexia with delayed relaxation, ataxia, or both

Paresthesia and nerve entrapment syndromes (eg Carpal Tunnel Syndrome)

Hyperprolactinemia  Galactorrhea
Gynecomastia

Decreased hearing, deafness

Decreased libido in men due to impairment of testicular testosterone synthesis

Decreased sense of taste and smell (anosmia)Difficulty swallowing

Impaired memory
Impaired cognitive function (brain fog) and inattentiveness.

A slow heart rate with ECG changes including low voltage signals. Diminished cardiac output and decreased contractility

Reactive (or post-prandial) hypoglycemia

Yellowing of the skin due to impaired conversion of beta-carotene to vitamin A (carotoderma)

Impaired renal function with decreased glomerular filtration rate

Acute psychosis (myxedema madness) (a rare presentation of hypothyroidism)

Macroglossia ( Enlarged tongue)

Some people with hyperthyroidism will have few and others will have many symptoms – each person is different. Also – groups of these symptoms may be caused by something else entirely and not indicative of hyperthyroidism. Help your doctor by keeping a note of all your own symptoms and ask their opinion. S/he will send you for blood tests and find out what’s going on.

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What is Hypothyroidism?

What is Hypothyroidism?

The pituitary gland and hypothalamus both control the thyroid. When thyroid hormone levels drop, the hypothalamus secretes TSH Releasing Hormone (TRH), which alerts the pituitary to produce thyroid stimulating hormone (TSH).

The major endocrine glands of the body. Pituit...
Image via Wikipedia

The thyroid keeps your metabolism under control with thyroid hormone, which it makes by extracting iodine from the blood.

Every cell in your body depends on the thyroid to manage its metabolism.

Hypothyroidism occurs when the thyroid fails to make enough of these hormones.

When the thyroid gland is unable to produce sufficient amounts of  thyroxine (T4) and tri-iodothyronine (T3) then problems start to occur in all of the body’s systems as the normal bodily functions start to slow down.

All the body hormones work together, so that changes in one effect others. When our body is young this generally works like a well oiled machine. When we pass middle age, the changes affect us more.

This is a possible reason why more women than men appear to be affected by hyperthyroidism especially after they turn 50.

There are three types of hypothyroidism.

The most common is primary hypothyroidism, in which the thyroid gland itself becomes diseased and fails to produce sufficient amounts of the thyroid hormone. The most common forms include Hashimoto’s thyroiditis (an autoimmune disease) and radioiodine therapy for hyperthyroidism.

Secondary hypothyroidism is caused by problems with the pituitary gland and accounts for less than 5-10% of hypothyroidism disorders. It occurs if the pituitary gland does not create enough thyroid-stimulating hormone (TSH) to stimulate the thyroid gland to produce the required amount of thyroxine and triiodothyronine. It is usually caused by damage to the pituitary gland, as by a tumor, radiation, or surgery.

Tertiary hypothyroidism results when the hypothalamus fails to produce sufficient thyrotropin releasing hormone (TRH). TRH prompts the pituitary gland to produce thyroid-stimulating hormone (TSH). Hence tertiary may also be termed hypothalamic-pituitary-axis hypothyroidism. It accounts for less than 5% of hypothyroidism cases.

Patients who have hypothyroidism should exercise caution with certain activities, especially if an activity has a risk of injury (eg, operating presses or heavy equipment, driving, heavy physical labour and contact sports. If their treatment is not yet stabilised and they are having difficulty maintaining concentration in low-stimulus activities, they may have slowed reaction times.

They may also be at risk for ligamental injury, particularly from excessive force across joints due to generalized hypotonia. Hypotonia is a state of low muscle tone (the amount of tension or resistance to movement in a muscle), often involving reduced muscle strength.

Hypothyroidism may be linked to other autoimmune diseases, such as Addisons disease, Chronic Fatigue Syndrome, Diabetes Mellitus, Euthyroid Sick Syndrome, Fibromyalgia, Lupus, Polyglandular Autoimmune Syndrome & Vitiligo.

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Thyroid

Your Thyroid Manages Your Metabolism

Front view of neck.
Image via Wikipedia

The thyroid is a butterfly shaped gland at the front of the throat just below the Adam’s apple. Our thyroid gland regulates our Metabolism and is responsible for creating hormones that drive several metabolic systems including our growth, both physical and mental, and our energy stores.

Around one in 20 people will experience some form of thyroid dysfunction (either overactive or underactive) in their life. Thyroid problems tend to affect a larger percentage of women more than men and the risk of thyroid dysfunction increases as you age.

Your metabolism is your body’s ability to break down food and convert it to energy. Food is like fuel for our bodies and each person uses it at a different rate. This is why you often hear about some people having  a fast or a slow metabolism.

Metabolism is determined by measuring the amount of oxygen used by the body over a specific amount of time. If the measurement is made at rest, it is known as the basal metabolic rate (BMR).

Differences in BMRs are associated with changes in energy balance. Energy balance reflects the difference between the amount of calories one eats and the amount of calories the body uses. A negative energy balance may lead to weight loss as occurs with hyperthyroidism. The BMR in a person with hypothyroidism is decreased, so an underactive thyroid is generally associated with some weight gain.

Measurement of the BMR was one of the earliest tests used to assess  thyroid dysfunction. Patients whose thyroid glands were underactive (hypo) were found to have low BMRs, and those with overactive (hyper) thyroid glands had high BMRs.

Hyper Or Hypo Thyroidism?

If you have Hyperthyroidism when your thyroid produces too much thyroid hormone, you may feel wired, anxious and impatient, you may also be prone to sweating and a pounding heart.

If you have Hypothyroidism when your thyroid hormone production is insufficient, you will feel the cold, get tired easily, feel slow, think slow and have insufficient energy to tackle things.

Diagnosis and Measurement of Thyroid function

Thyroid dysfunction is diagnosed after blood tests are taken and may be treated with drugs or sometimes surgery. An overactive thyroid may be suppressed by taking a specific drug. An underactive thyroid is generally treated with a supplement of thyroid hormone. The patients doctor will order blood tests every 6 weeks to three months until the right dose is settled on. Blood pressure, pulse rate and body temperature are simple checks that people can make to chart their treatment progress themselves.

If you have had tests done and need help to decipher them check out Optimal Lab Values

This info is a bit simplistic. Different types of thyroid disease will require different treatments. The thyroid gland may be damaged in many different ways, so you will need to look for websites with comprehensive Thyroid information that is specific to your personal diagnosis. The following 2 websites  gives simple easy to understand information.

Endocrine Web information on thyroid dysfunctions.

Web MD info on thyroid dysfunction

 

 

 

 

 

 

 

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Equivalent Thyroid Hormone Brand For Australia

Thyroid Hormone Brands

(Article republished from the Australian Thyroid Website – see credit below)

Every day millions of Americans take a small pill to compensate for a lack of thyroid hormone in their bloodstream. The drug of choice for the treatment of this and other thyroid disorders is synthetic levothyroxine sodium. The American Druggist listed two brand-name preparations as the 3rd and 51st most prescribed drugs in the United States during 1996, accounting for over 36,000,000 prescriptions of synthetic levothyroxine last year. Physicians and scientists may use different scientific names for levothyroxine, such as L-thyroxine, thyroxine, and T4 ; however, all of these terms refer to the same chemical. Thyroid hormone replacement with synthetic levothyroxine is safe, simple, effective, and relatively inexpensive.

THYROID HORMONE PREPARATIONS
UNITED STATES
BRAND-NAME LEVOTHYROXINE
Euthyrox®
Levothroid®
Levoxyl®
Synthroid®
GENERIC LEVOTHYROXINE
levothyroxine sodium USP
L-thyroxine
DESICCATED ANIMAL (“natural”) T4 /T3
Armour®
SYNTHETIC T4 /T3
Thyrolar®
SYNTHETIC T3
Cytomel®
AUSTRALIA
BRAND-NAME LEVOTHYROXINE
Oroxine®
Eutroxsig®
GENERIC LEVOTHYROXINE
DESICCATED ANIMAL (“natural”) T4 /T3
Dartnells Pharmacy
Stenlake Pharmacy
SYNTHETIC T4 /T3
SYNTHETIC T3
Tertroxin®

History of Thyroid Hormone Replacement

From the late 1890’s until relatively recently, physicians worldwide have treated hypothyroid patients with tablets containing desiccated (dried and powdered) animal thyroid glands. These tablets contained both levothyroxine (T4) and triiodothyronine (T3). In 1958, the first synthetic levothyroxine tablets were marketed in the United States. Because thyroid hormones were on the market before the Food and Drug Administration (FDA) laws were in place, manufacturers of these hormones were not required to meet the extensive testing requirements of safety and effectiveness required of all new drugs introduced after 1938. In other words, thyroid hormone replacements, such as synthetic levothyroxine, were “grandfathered” into the system; consequently, there are no FDA approved procedures or standards for testing these preparations other than specifying that each pill contain between 90% to 110% of the stated chemical content.

Who Needs It?

The majority of patients taking levothyroxine have a permanent form of hypothyroidism and will take one pill, every day, for the rest of their lives. The causes of permanent hypothyroidism are listed below:

  • Hashimoto’s thyroiditis (a chronic inflammation of the thyroid gland)
  • Radioactive iodine treatment for hyperthyroidism
  • Surgical removal of part or all of the thyroid gland
  • Congenital abnormalities, including an absence of the thyroid gland
  • Iodine deficiency
  • Radiation for cancers, such as Hodgkin’s disease
  • Pituitary or hypothalamic dysfunction
  • Unknown causes (idiopathic)

Levothyroxine therapy may also be indicated for patients with goiter, solitary thyroid nodule, multinodular goiter, thyroid cancer, thyroiditis, and hyperthyroidism treated with antithyroid drugs. In addition to the thyroid disorders listed here, some physicians have found that levothyroxine can enhance the effectiveness of certain antidepressants and use it temporarily to treat depressed patients.

Thyroid Hormones in the Bloodstream

Levothyroxine (T4) and triiodothyronine (T3) are the thyroid hormones that circulate throughout the bloodstream. The thyroid gland is the sole source of T4 . However, only 10% to 20% of T3 is made in the thyroid gland; the remaining 80% to 90% is produced when T4 is broken down into T3 by other organs in the body.

When a patient takes levothyroxine, the level of T4 in the blood rises and falls slowly. On the other hand, when a patient takes medications containing the much more potent T3, the blood level of T3 rises quickly to hyperthyroid levels and falls rapidly. Therefore, preparations containing T3 cause patients to become hyperthyroid several hours a day. Substituting one disease–hyperthyroidism–for another is not desirable.

Synthetic vs. “Natural” Thyroid Hormone

Nearly everyone can take synthetic levothyroxine; it is identical to the body’s own T4 . However, some patients, thinking that “natural” means better, prefer natural thyroid hormones, which are made of desiccated animal thyroid glands. Thyroid hormones derived from animals invariably contain T3 and, as previously noted, should not be used because they can cause hyperthyroidism. Another advantage of synthetic levothyroxine is that it has a longer shelf life than natural thyroid hormones.

Brand-Name vs. Generic

There are three well-tested, brand-name levothyroxine preparations available in the United States for the treatment of thyroid patients: Levothroid®, Levoxyl®, and Synthroid®. ( By the end of this year, Euthyrox®, which is marketed in twenty-nine other countries, will become the fourth brand-name levothyroxine product to be sold here.) Although there may be differences in the manufacturing, composition (dyes and fillers), and absorption rates among these prep-arations, each of these brand-name products is reliable and offers predictable results. Although changing from one brand to another does not usually cause problems, it is preferable to take the same brand consistently.

Generic levothyroxine tablets have not been widely recommended for several reasons:

  • Scientific studies have shown that, for some generics, the T4 content of each pill can be outside the FDA range of 90% to 110% of the stated chemical content. While a 20% range may not be a significant factor for some drugs, very small amounts of thyroid hormone can make quite a difference in the treatment of thyroid patients. For example, for some patients, a 12.5% variation in levothyroxine dosage can mean the difference between hypothyroidism or euthyroidism (having the proper amount of thyroid hormone in the body). Therefore, it is essential that patients with thyroid disease take the exact amount of prescribed levothyroxine to ensure successful treatment.
  • There have been additional concerns about the quality control in the production of generic levothyroxine, especially since generic manufacturers tend to come and go in the marketplace with great frequency, making them less accountable than long-standing manufacturers of levothyroxine. The 1997 Red Book, a pharmacist’s guide to prescription generic and brand-name drugs, lists twenty-five companies distributing synthetic levothyroxine. (Some of these companies manufacture and distribute levothyroxine tablets, and others just distribute them.) Since publication, many of the listed companies are not making or selling synthetic levothyroxine.
  • From prescription to prescription, patients may be given a different generic preparation each time, making it impractical, if not impossible, to determine if retesting patients’ thyroid hormone levels is necessary.
  • While brand-name levothyroxine preparations come in eleven to twelve different strengths, generics have less variety of strengths from which to choose. Of the generic levothyroxine distri-butors listed in the Red Book, 44% have one to four strengths available; the remaining offer five to eight strengths. For patients whose levothyroxine dosage must be adjusted several times due to age or other medical conditions, it would be difficult to stay with the same product if certain incremental changes are made.

THYROID FACTOIDS
  • Synthetic levothyroxine is the treatment of choice for thyroid hormone replacement; brand-name levothyroxine is preferable to generic preparations.
  • A diagnosis of permanent hypothyroidism requires lifetime treatment with levothyroxine.
  • The average dose of prescribed levothyroxine is between 100 mcg (0.1 mg) and 125 mcg (0.125 mg); one-third of the levothyroxine prescriptions filled are for 100 mcg.
  • If the type, brand, or dosage of levothyroxine is changed, patients should have their blood levels of thyroid hormones checked two to three months later.
  • Taking more levothyroxine than prescribed does not speed up recovery and may cause hyperthyroidism and osteoporosis (thinning of the bones).
  • Taking the proper dose of levothyroxine will not increase a patient’s risk of developing osteoporosis.
  • Levothyroxine treatment is not indicated for patients with fatigue, obesity, or infertility unless the patients also have a confirmed diagnosis of hypothyroidism.
  • The warning on some non-prescription cold and flu preparations to avoid taking them if the patient has thyroid disease does not apply to hypothyroid patients taking levothyroxine in the prescribed amounts.
  • Pregnant women and nursing mothers can safely take levothyroxine. In fact, patients with inadequately treated hypothyroidism have an increased risk of miscarriage

LEVOTHYROXINE PRICES – HOUSTON
Findings of a very informal, “unscientific” survey of levothyroxine prices at four Houston pharmacies in July 1997. If you are concerned about the cost of your thyroid hormone replacement, do your own “survey” by calling several of the pharmacies in your area.
Levothyroxine
100mcg/0.1 mg
100 Tablets
Chain One Chain Two Independent
One
Independent
Two
Synthroid® $22.99 $22.49 $42.50 $33.65
Levoxyl® $9.99 $11.09 $29.00 $21.70
Levothroid® $22.99 $11.09 $26.70 $35.00
generic Levoxyl® Levoxyl® $35.00 Levoxyl®
* Pharmacy uses Levoxyl® to fill generic prescriptions.
NATIONAL COMPARISONS
Levothyroxine
100mcg/0.1 mg
Average Wholesale Price
for 100 Tablets
Synthroid® $22.70
Levothroid® $18.56
Levoxyl® $12.17
generic $3.05 to $21.45
In Australia the supply of Oroxine® is covered by the Pharaceutical Benefits Scheme and patients can expect to pay $15.00 for 200 100mcg tablets

The question of brand-name versus generic levothyroxine has never been more controversial or hotly debated than in the last year. An article in the April 25, 1996 issue of The Wall Street Journal revealed that the brand-name manufacturer who controls 84% of the levothyroxine market in the United States was trying to withhold the results of a study it had commissioned. The controversial study was eventually published in the April 16, 1997 edition of The Journal of the American Medical Association. Designed to determine whether two generic levothyroxine products and two brand-name levothyroxine products were bioequivalent, the study concluded that the four drugs tested were bioequivalent and could be used interchangeably. Since that time, scientists and physicians have debated the merits, flaws, and significance of the study. Interestingly, the two generic levothyroxine preparations used in this controversial study were actually manufactured by the same company and distributed by two other companies. Since the time of the study, one company, after switching manufacturers, has discontinued distributing levothyroxine tablets. The second company has also switched to another manufacturer and is currently distributing only one strength (25 mcg) of levothyroxine.

Where does the controversy surrounding brand-name vs. generic leave thyroid patients who depend on levothyroxine? Will physicians change their guidelines for prescribing levothyroxine? Both the American Thyroid Association (ATA) and the American Association of Clinical Endocrinologists (AACE) publish guidelines for the treatment of hypothyroidism. AACE guidelines still recommend a brand-name preparation of levothyroxine over a generic; the ATA guidelines state that levothyroxine sodium is the treatment of choice, without specifying brand-name or generic. However, both the ATA and AACE recommend that patients be retested and their dosage adjusted accordingly if patients switch levothyroxine products. (Neither The Endocrine Society nor the National Institute of Diabetes and Digestive and Kidney Diseases-the division of the National Institutes of Health that studies thyroid disease-has published guidelines for the treatment of thyroid disease or has a stated position concerning the brand-name vs. generic issue.) Because the FDA regulations only concern the amount of stated chemical content and because researchers cannot seem to agree on the most reliable and relevant methods for testing and comparing levothyroxine preparations, it appears likely that the controversy of brand-name or generic will continue for some time. Until more testing, evaluation, and information become available, The Thyroid Society believes that it would be prudent to continue to follow the same course of action that has yielded reliable, consistent results with a minimum of additional laboratory tests and office visits. Brand-name synthetic levothyroxine can assure physicians and patients predictable results and is, therefore, the levothyroxine preparation of choice.

Cost Factors

Patients may be concerned about the costs involved in lifetime thyroid hormone replacement. Compared to other drugs, levothyroxine is relatively inexpensive. As can be seen in the table National Comparisons, the average wholesale price for the three leading brand-name levothyroxine products in the U.S. varies as much as 40%.The previously mentioned controversial study implied that generics could save consumers a great deal of money, and, indeed, most people expect generics to be less expensive than brand-names. In fact, generic prices can either be much less expensive or more expensive than a given brand-name product, depending upon the manufacturer, distributor, and pharmacy (see table Levothyroxine Prices – Houston). Depending on where you buy your generic levothyroxine, it might cost more than a brand-name. If cost savings is the incentive to switch to generic levothyroxine, the additional laboratory testing and office visits recommended when patients change from one levothyroxine product to another could offset or exceed any perceived cost savings. Some patients have expressed concern that their managed healthcare program will restrict the use of brand-name levothyroxine. Each managed healthcare plan has developed a list of drugs (a formulary) that they will cover for certain diseases. Typically, the patient pays a flat rate, or co-pay, for each prescription they have filled, regardless of the actual cost of a drug. Some plans only allow a 30-day supply of any medication to be filled at one time. If the average co-pay is $5, the patient will spend a total of $15 for 90 tablets of levothyroxine-generic or brand-name-and will go to the pharmacy three times. The patient might have spent less money and avoided two additional trips to the pharmacy by paying in full for a prescription of 100 tablets of a lower priced brand-name levothyroxine. Patients should discuss with their physician any financial concerns they have about levothyroxine so that the physician can take this information into consideration when prescribing the best treatment for the patient. In addition, thyroid patients with managed healthcare plans can discuss their concerns about their treatment with the plan’s administrator.

Dosage

The exact amount of levothyroxine prescribed to correct thyroid disorders must be individualized for each patient. When determining the initial dose of levothyroxine, physicians take several factors into consideration:

  • The patient’s age
  • The patient’s weight
  • The patient’s heart status
  • The severity of hypothyroidism

The majority of patients can be started on full thyroid hormone replacement. Patients with a history of heart problems are sometimes started on an a relatively low dosage-25 mcg (0.025 mg) to 50 mcg (0.05 mg)-of levothyroxine. [EDITOR: In Australia, Sigma Pharmaceuticals, the maker of Oroxine, recommends that all patients start on a low dose. It is Thyroid Australia’s experience that petients starting on a full dose frequently experience overdose symptoms.] The amount of levothyroxine is gradually increased every four to six weeks until the patient becomes euthyroid.

Patients who have had their entire thyroid surgically removed because of thyroid cancer typically require considerably higher doses of levothyroxine than patients with Hashimoto’s thyroiditis who have some remaining thyroid function. In addition, women taking estrogens for birth control or menopause may require higher doses of levothyroxine. Patients should not expect to feel better immediately after beginning treatment with levothyroxine, even if the initial dosage is correct. It may take six weeks or more before they experience a full response to treatment. Patients are usually re- examined and have repeat thyroid function tests two to three months after they are started on levothyroxine. If dosage adjustments are necessary, patients are re-examined and tested in another two or three months. Once patients’ thyroid hormone levels are within the proper range, they are ordinarily seen no less than once a year. Physicians may change patients’ levothyroxine dosage for various reasons, including aging and changes in patients’ medical condition.

Patients who become pregnant or start taking estrogen should see their physician two months later to determine if their levothyroxine should be increased. Pregnant women should also be checked again when they are five to six months pregnant and three to four months after they deliver. Additionally, adjustments in the dosage of levothyroxine are sometimes necessary because of changes in the thyroid disease itself. For example, if a patient is being treated for hypothyroidism due to Hashimoto’s thyroiditis, over time, this inflammation could damage additional thyroid gland tissue, causing it to produce even less thyroid hormone.

When to Take Levothyroxine

Levothyroxine should be taken daily, unless otherwise directed by the physician. For patients who have trouble remembering to take their medication, inexpensive pill boxes can be helpful. If a pill is forgotten, the patient can either take it the next day or at the end of the week. (“Doubling up” on other medications is not advisable without first checking with a physician.) Since food- especially high-fiber food and soy bean products- can interfere with absorption of levothyroxine, it is best to take levothyroxine on an empty stomach, twenty to thirty minutes before breakfast. Several drugs can also cause absorption problems. For example, Feosol®, Fergon®, prenatal vitamins, and other preparations containing large amounts of iron can significantly interfere with levothy-roxine absorption. Another drug that can cause problems is sucralfate (Carafate®), which is used in the treatment of ulcers and esophagitis. Therefore, iron and sucralfate should be taken two to four hours after levothyroxine. Patients should also avoid taking levothyroxine and antacids containing aluminum hydroxide at the same time. Drugs used to treat high cholesterol, such as Questran® and Colestid® have an even more dramatic effect on levothyroxine absorption. These drugs should be taken at least four hours, and preferably twelve hours, after levothyroxine. The effects of drugs, supplements, and diet on levothyroxine absorption can be significant. Therefore, it is always advisable for patients to tell the physician treating their thyroid disease about all of the other medications or supplements they take. It is also important for thyroid patients to tell physicians treating them for other disorders that they are taking levothyroxine. The Thyroid Society strongly encourages patients to discuss their concerns about levothyroxine therapy with their physician. Each patient is unique, and the physician managing their disease is in the best position to advise them on their treatment plan. By focusing this edition of The Thyroid Connection on levothyroxine therapy, The Thyroid Society hopes that patients will better understand the importance of taking their thyroid hormone replacement and that they will find it easier to follow their physician’s instructions.

This article is reproduced in full and acknowledges the source below
(c) Copyright 2001, Thyroid Australia Limited ABN 71 094 832 023
333 Waverley Road, Mount Waverley, 3149, Australia
Thyroid Australia Home – www.thyroid.org.au

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