NEWS: Monitoring thyroid hormone therapy is necessary

Original article HERE

Monitoring Thyroid Hormone Therapy Is Necessary - Marilyn Linton

More than a century ago, a 46-year-old woman's life was saved when her dangerously underactive thyroid was treated with dried sheep's thyroid. Since then, thyroid hormone therapy has become the gold standard of treatment for hypothyroidism (an underactive thyroid gland), though the hormone, called levothyroxine, no longer comes from the minced up glands of animals.

In fact, levothyroxine (produced in a lab) is among the top five prescription drugs sold in North America. Over nine million prescriptions for Synthroid, one brand of levothyroxine, were written in Canada in 2005, making it the second top-selling drug next to cholesterol-lowering Lipitor.

These drugs, also known as L-thyroxine or T4, provide for the thyroid hormone if your thyroid gland is unable to make enough. And there are lots of underactive thyroids out there, because hypothyroidism affects three percent of the world. M. Sara Rosenthal, a thyroid expert, writes in The Thyroid Sourcebook that roughly four to seven percent of people over the age of 60 are hypothyroid.

An aging society that's increasingly hypothyroid explains, in part, the zillions of pills taken annually; but many younger people also take it to address fatigue, cold intolerance, depression and a host of other everyday maladies. There's also the view that thyroid supplements work as a weight management tool. So no wonder that this medication has shifted in the public's mind from life-saving medicine to life-enhancing therapy.

Now, a recently published study underlines the fact that thyroid supplements are potent medicines that should be monitored annually by a doctor and respected by those who take it. In the study, conducted by a team of researchers from Toronto, elderly people who were taking medium to high doses of levothyroxine were found to have had two and a half to three times greater chance of suffering from a fracture than those who were taking a lower dose.

Eighty-eight percent of the people studied were women, says Dr. Lorraine Lipscombe, research scientist at the Women's College Hospital Research Institute. "We wanted to see if there was an effect of levothyroxine treatment on the risk of fracture on persons over the age of 70. Results of our study suggest that maybe these people were getting too much thyroid because their fracture risk was higher with these higher doses."

Of the 213,511 people studied, a total of 22,236 (10.4 percent) of people experienced at least one fracture during the study period which was between 2002 and 2007. The study was done using population health data bases in Ontario; hospital records were used to identify fractures.

The majority of people are diagnosed with hypothyroidism in middle age, she explains. "While initially they get monitored to try to get the right dose, once the right dose is determined, often times they stay on the same dose for years." As people age, their thyroxine requirements fall but their doses often remain unchanged into old age. "We are beginning to realize that the dose that was appropriate for them in middle age is no longer appropriate for them as they enter older age. People who are on thyroxine should go to the doctor and make sure that they have had a recent blood test to see if they're on the right dose."

Regular dose monitoring may not be done for a variety of reasons: People who have been on one dosage for years and who feel good on it may assume that the dosage is still appropriate; doctors themselves may overlook their patients' need for a blood test (which is necessary to confirm thyroid hormone levels), particularly when older patients present with other problems that need tending to.

Experts report that too much thyroxine speeds up the body's metabolism and thins the bones, but it isn't just the fractures that are worrisome. Too much of this hormone increases the risk for serious heart arrythmias, and muscle weakness. "Our job with this study was to raise awareness that thyroid hormone levels need monitoring. We estimate that about 20% of seniors are taking levothyroxine, so this has a big impact."

New guidelines?

The study, published in the British Medical Journal, suggests that the ideal dose of thyroid drugs should take the age of the patient into consideration. In Canada, one levothyroxine brand is called Synthroid; another is Eltroxin. If you're taking either, do not stop them, but check with your doctor at your next appointment about whether your dose needs to be changed.

The butterfly gland

The thyroid, a butterfly shaped gland situated at the base of the throat, naturally secretes a hormone that is responsible for regulating the metabolism rate of the body. Hypothyroidism, the lack of thyroid hormone, is treated with levothyroxine.

The Thyroid Sourcebook

M. Sara Rosenthal's excellent book tells you everything you need to know about the thyroid, its diseases and disorders. The thyroid cancer survivor and consumer health specialist also covers the latest treatment options and complementary therapies, the best tests, and how to spot bogus websites in the thyroid e-health movement.

The Thyroid Sourcebook - M. Sara Rosenthal Ph.D

The Thyroid Sourcebook For Women - M Sara Rosenthal Ph.D

The Birds & The Bees...and Aliens.

Up early to go to the doctors this morning. But no matter how early we get there, we're never first...do the locals camp out there overnight, seriously? Might go the night before in the camper van myself next time!

Dragged the husband along with me this time. He's got an alien growing on his foot, and he's been whingeing about it for ages, but then refusing to go to the doctor's about it...so I tricked him, by saying that I hoped to discuss our brand-new baby-making future with her, and wanted him there for the discussion. Sneaky wife!

Turns out its not an alien after all...its a ganglion (AKA Bible Bumps)...and that means I can legitimately thump him with heavy books, even the doctor said so**. But in the meantime, in case my domestic abuse with heavy books doesn't work, she's going to refer him to the local hospital to have it removed under local anaesthetic.
(**Apparently, the old-fashioned treatment for ganglions was to hit them with heavy books, most commonly Bibles!)

We did discuss our future of baby-making, so I didn't totally lie to him. We have agreed that I will stop my current blood pressure meds, Omesar Plus. As they are *NOT* suitable for use during conception, pregnancy etc. My blood pressure this morning was 145/67, which she was pleased with. I am to start taking my blood pressure regularly at home again, now that I am stopping the meds (I let that habit slip a little ) and if it does start to rise again, she can prescribe me another pregnancy-friendly BP med instead. We postulated that since my thyroid levels were now good, as well as stable...that any lingering blood pressure issues are now solely down to my weight/lifestyle. So if it stays down, even after I have stopped my HBP meds, then I will be doubly happy.
We also discussed my age, and how that was a factor, time was against me etc etc. And whilst she would normally advise couples to go off, have fun, and come back if nothing has happened after a year...given my age, and pre-existing health issues, she has advised that we come back after 6 months instead if there is no 'stork' news, so we can start looking for, and dealing with, any problems sooner.

Obviously, I need to start taking the pre-pregnancy vitamins again - I stopped them after my Difene scare earlier in the year - I cut out everything pill-wise that was non-essential for a while, and then I didn't get back into the habit of taking them again. I will be taking Pregnacare Plus

On the subject of Difene - she has prescribed me an alternative pain-killer, just for those really bad (thankfully rare) days when paracetamol just isn't cutting it on those period pains. Fingers crossed this one doesn't have me heading to hospital in an ambulance again!

Almost forgot...shameful since this IS predominantly a thyroid blog...she also took routine thyroid bloods for testing. Been 3 months since my last set, and if these are OK, which I'm confident they will be, we'll go to 6-monthly intervals.

Until next time...I'm off to weigh some books, and pick out the heaviest ones!

NEWS: Thyroid drugs raise fracture risk

Original Article here: Thyroid drugs raise fracture risk

Many seniors are at high risk for fractures because they take ‘excessive’ doses of drugs used to treat thyroid problems.

Many patients with hypothyroidism are diagnosed in early or middle adulthood. Even though their treatment requirements change as they age, many patients remain on the same drug dose. This can lead to excess levels of thyroid hormone, which raises the risk of fractures, especially in older women.

Researchers examined the link between fractures and levothyroxine, a synthetic form of thyroid hormone, which is widely used to treat an underactive thyroid gland (hypothyroidism). They analysed data from over 213,511 Canadians, aged 70 years or older, in Canada who filled at least one prescription for levothyroxine between April 2002 and March 2007. During the study period, more than 22,236 (approximately 10 percent) of the patients suffered at least one fracture.

Current and recent past users (who had discontinued the drug 15 to 180 days before the start of the study) had a significantly higher fracture risk than ‘remote’ users (who had discontinued use of the drug more than 180 days before the start of the study). Among current users, those who took high or medium doses of the drug were much more likely to suffer a fracture than those who took a low dose.

These findings provide evidence that levothyroxine treatment may increase the risk of fragility fractures in older people even at conventional dosages, suggesting that closer monitoring and modification of treatment targets may be warranted in this vulnerable population. Also, treatment targets should be modified in elderly patients with thyroid problems and that regular dose monitoring of thyroid drugs is essential in older age.

Tuesday, 07 June 2011

Read more at: http://doctor.ndtv.com/storypage/ndtv/id/5199/Thyroid_drugs_raise_fracture_risk.html?cp

One Year On!

One whole year since my Total Thyroidectomy!

And in the last 365 days, I have had highs, lows, good days & bad.....but more and more of the highs, and more and more of the good days, as the year has progressed.

My total thyroidectomy has changed my life for the positive in more ways than I can count....but here are a few:

My levels have a found a sweet spot, that the Levothyroxine dose I am on (150mcg) seems to maintain (10 months and counting!), where my symptoms are minimal and my outlook on life is positive.

I've started my own business....one that I have wanted to start for a very long time, since before I was made redundant in 2008 from my ultimate dream job. Originally, it was intended to run seamlessly alongside aforementioned dream job....but thanks to my thyroid disease and the psychological roller coaster of Graves/hyperthyroidism, I never seemed to have the drive or motivation to take the idea past the initial planning stage. it was planned, and planned, and planned. Products found, suppliers sourced, sales opportunities identified...but for more than 5 years I just couldn't take the next step into setting it up for real.
In a couple of months time my business will also see its first anniversary...and its still overwhelming to see how it has taken shape, to see how far we've come already, and the feeling that the idea is out of my head, in the real world, and its working!

And perhaps the most exciting bit of positive news...at my last Endo appointment, he gave us the green light to start trying for a family. To celebrate, I went in to Boots on the way home, and availed of their 3-for-2 offer on Pregnacare+ Conception vitamins...don't tell me that I don't know how to party!!!
OK - so that may well be a long and fruitless road for us, given my age and other factors, and we'll start that journey with realistic expectations...but after so many years of being told by my medical team that we can't....well, it so unbelievably good to now be told that we CAN!

And so, I wish a happy birthday to my TT scar...as that is all that remains...

This is NOT an April Fool!

"Hello love, this is not an April Fool" is how I started the telephone call to the husband this morning.

"But I really don't feel very well, and I think I need an ambulance" is how it continued.

Can only imagine how the poor fella felt upon hearing these words. He was over an hour away in Kilkenny this morning, instead of being at the farm less than a mile away...but I felt so odd, so very ill, and I knew the quickest way to get an ambulance here was to let him deal with it.

We live in a rural part of Ireland...where your address is your townsland, not your property name. Properties around here don't generally have nice identifying names, like "The White Cottage" or similar, and a host of local houses, farms and dwellings would all share the same postal address. And roads don't have names or numbers either. We've been here for 7 years, but if chatting to a local, trying to describe where you live, all efforts draw a blank face, until you say its T** M****'s old cottage or next to J** E*****'s dairy parlour...and then the facial expression changes to one of total recognition. And I knew that time was running out for my mental capacities, and me trying to explain to the Emergency Dispatch operator where exactly to send the ambulance was going to be nigh on impossible. So I handed that responsibility to my husband so that I could concentrate on trying to remain upright, and trying to keep breathing...a feat which was getting more and more difficult to maintain by the second.

What was going on? Well, at the time I didn't have a clue. All I knew was that something was seriously wrong. It had come on suddenly, and was getting worse, very quickly!

That morning, as usual, I got up, set the coffee machine going, took the dogs out for a wee, poured a mug of coffee. Took a blood pressure pill, with a swallow of coffee. I'd been up a bit during the night with bad period pains, and could feel them just starting to niggle. Day 2 of my cycle,and if any day is going to be bad, typically it is day 2....so as I have done, on every other bad cycle day (thankfully few 7 far between) I decided to take a Difene, to get a head start on it, before the pain took hold and nothing would shift it. Difene shouldn't be taken on an empty stomach, but not feeling hungry, I drank a glass of milk with it instead. As I have done almost every other time I've taken it, or other meds that need to be taken with or after food.

I settled with my mug of coffee, to watch a bit of mindless television, do a bit of knitting (rock & roll!) and sort out in my head what I needed to do for the day ahead.

Then, woompf...my head felt hot, very hot, psycho hot...like it was going to explode. I swear, if I'd looked in a mirror at that very second I would not have been surprised to see my whole head raspberry red and glowing. Then the itching started...mad itching, everywhere, I just couldn't scratch fast enough, hard enough, or in enough places at the same time. It felt like my entire skin was crawling. Then my heart started racing, I had the sense of mind to check my pulse in my neck, and it came back at a whopping 130/min...yikes! I fumbled for my home blood pressure machine, and struggled to get it on my left arm...all the while the itching was unbearable, and my head was boiling. "ERROR", try again, "ERROR". Chest feels tight, struggling to get air in....so that's when I decided I needed to make a call. "Hello love, this is not an April Fool..."

I tried 3 more times to get the blood pressure machine to take a reading, but I just kept coming back with "ERROR".

Husband phones back, the ambulance is on its way.

So, my practical side kicks in, and I think of the things I need to do before they get here whilst I can still just about stand and move about. Legs are very wobbly, breathing is now really hard work and my head is spinning with mega-dizzy spells, but I get the dogs shut away. I find my hoody, and make sure my mobile phone is in my handbag. I put my handbag near the front door. I grab my meds box and stick it on the kitchen table. That way I can easily direct the paramedics to see what I have taken that morning. I am surprised looking back now, remembering how awful (and scared) I felt at the time, at how sensible, practical and organised I was, in getting stuff sorted and ready for their arrival. But by the time they got here (not sure how long, but less than 10 mins) I had given up. Front door was wide open, bedroom door was wide open, and I was lying on the bed, unable to stand up anymore, in total agony from severe abdominal pains which have come out of nowhere, and seemingly have come to join the *fun party* that the rest of my body is having at my expense. My head is feeling like a piping hot baked potato, chest so tight I can barely draw breath, my speech is slurred and finding words in my head is almost impossible and my pulse has now massively slowed down and is so feint I can hardly feel it. And, whilst going through all this, all I can think of is "I hope ***** isn't working today because the house is a mess!" (our landlord is a paramedic).

When they do arrive I see that another paramedic friend is working today instead, and the very first thing I manage to blurt out is "I'm so glad its you working and not *****, please don't tell him about the mess in the hallway." A girl has to get her priorities right! But that outburst takes away all my remaining energy, and I collapse back on the bed, and can only then manage to grunt and gurgle at them in answer to all the questions they're firing at me. I have stuff stuck on me, things poked in me, torches shined at me, hands pressing me, and feel their blood pressure cuff inflating again and again and again. Its not reading, so they take a 2nd blood pressure machine out of the ambulance and that takes two more efforts before it finally gives a reading....low, very, very low...obviously too low for my humble home machine to detect, and the paramedic's first machine couldn't read it either. They do more stuff to me, fire more questions at me, then I'm put in the ambulance.

Various sticky electrodes are stuck on me, and I'm plugged into the heart trace machine. The abdominal pain is becoming totally unbearable, being strapped flat on the ambulance trolley is not helping, I feel I want to curl up in a tight ball and moan loudly, instead they plug the happy gas mask on my face. My friend is wondering if I've tweaked my vagus nerve, causing the blood pressure to crash. But that only explains one symptom doesn't it. I'm feeling a little better, and almost able to hold a proper conversation. But the abdominal pains are coming in waves now, so I go quiet every now and then and ride the pain through as best I can.
We discuss last night's meal, in case food poisoning is another option. But I get the impression he's really scratching his head over this one.
The conversation keeps coming back to the Difene. Did I eat anything, have I taken it before, why did I take it, what as it prescribed for.
At one point I ask them to turn back (only half joking) because I've left my knitting on the table. Surprisingly they don't.

When we get to the hospital I feel fine. I really do feel fine. I joke that if they are heading back to my home town (where the local ambulance station is located) could they give me a lift. They are having none of it, and I'm taken into the A & E department. By this time my blood pressure is almost back to normal. My blood sugars are good (they always check this, I obviously look like I *should* be diabetic). My pulse is back to normal. Only the dizziness and abdominal pains remain. They are similar to period pains, but in slightly the wrong place.

The duty doctor tries to take bloods...I say tries...I really have no idea what he was doing. But by the time he'd finished there was blood all down my top, all down my arm, all over the bed, all over my thigh...and very little in the sample tube. He stuck a cannula in, so that if more was needed he didn't have to go digging. I swear I looked like car crash victim by the time he finished taking blood. I am SO thankful to have a wonderful GP who is seemingly a true artist when it comes to taking blood samples...no pain, not even a scratch, no marks, nothing. If I would give her 10/10 for her phlebotomy skills, I'd struggle to give the A &E doc 1/10...! I don't know quite how he did the cannula either, but all the while the cannula was in I couldn't bend that arm, and it was almost constant pain, felt like I had a knife in there, stuck at right angles. Perhaps it was intentional, to keep my mind off my other symptoms?

He paraded a line on fellow doctors past me, all asking the same questions and doing the same things to me. But it all kept coming back to the Difene.

Then the news filtered back from the labs that the first blood samples had haemolyzed...quelle surprise! And so he came at me with the test tubes again for more blood...and even with cannula in place, still managed to spill more blood all down me!

At this point the abdominal pains were all but gone, and I hadn't had a dizzy spell for a while. Getting fed up with his incompetence, I was ready to go home. But oh no, he was adamant that I needed to be admitted overnight, for observation. We had a bit of a row over it, and he dragged out a form for me to sign, acknowledging that I was leaving against medical advice. I said I didn't want to leave against medical advice, but I didn't want to take up a precious bed space when I was clearly feeling fine, so would much rather he discharged me.

The bloods came back fine. They also did a thyroid panel, standard procedure because I don't have a thyroid gland, but those results wouldn't be back for 2 days. But the immediate blood results were all grand. I repeated that I wanted to go home. He insisted I stay in overnight. Round and round we went.

I got sent to the Clinical Assessment ward. 3 More consultants came and asked me the same questions, poked me in the same places, and all muttered about Difene. One more consultant came in, read through my notes, murmured to himself. Then stated that whilst they would like me to stay in for observation, they were also happy for me to go home if I preferred, on the understanding that if any of the symptoms occurred again I was to come straight back. Yay! A compromise I was entirely happy with! They removed my sexy hospital ID bracelet, and a nurse, sent from the gods, finally removed the evil cannula...without spilling a single drop of blood, amazing! The final diagnosis was that although they couldn't say 100%, the mostly likely candidate was an anaphylactic reaction to the Difene. Mild in many ways (no throat swelling etc), serious in others (racing pulse, BP crash, shortness of breath), but if that was mild, I can only imagine how scary a full-on anaphylactic attack is...this morning I was truly terrified.

My husband rocks, and I apologise wholeheartedly for giving him the phone call from hell this morning. The remaining Difene tabs are going back to the chemist tomorrow, to be disposed of.

News Article: High Security RAI Alert at Customs

Original Article here: Cancer patient recovering from radiation therapy sparks alert at Dover port - mirror.co.uk

A cancer patient recovering from radiation therapy sparked bomb fears as he drove off a Channel ferry.

Officials checking for radioactive material stopped Peter Davies, 60, after he set off detectors at Dover.

He was allowed through only after he showed a letter detailing the thyroid cancer treatment he'd had a fortnight earlier at St Bart's, London.

Mr Davies, of Witham, Essex, who was returning from France with partner Pauline Marr, said: "It was all good-natured. I know they have to take precautions."

Read more:
http://www.mirror.co.uk/news/top-stories/2010/07/15/cancer-patient-recovering-from-radiation-therapy-sparks-alert-at-dover-port-115875-22414026/#ixzz0tqZNjWCD

Cowboys, handbags & my new Endo

I seemed to be waiting an inordinately long time for my pre-appointment visit with the nurses (the dreaded weighing chair), and so I took some time for people watching in the over-crowded waiting room. Over-crowded because in the three weeks since I was last there, the contractors have moved in, blocked off the main corridor access for the out-patients department, and put up a wall where once there was ample seating, and thus reduced the waiting area in the busiest out-patient departments to less than half the space...chaos, and so unrecognisable that I walked straight through the place, after taking a double look in confusion, only to find myself in OP2, wondering how I'd got there without walking through OP1.

The first thing I noticed were all the new faces with ID badges, shiny new interns bustling about. Some over-brimming with confidence, and looking like they'd settled right in....others looking like they still didn't know where they where, why they were there or what was happening....I reminded myself to ask specifically for the senior registrar...just in case I was unfortunate enough to be allocated to one of the latter. Another thing that struck me about the female interns was that they all seemed to be surgically attached to their handbags...every time they came out of the consultation room, to go to the nurses station in order to collect the next patient's file, the handbag was there, hanging off the shoulder. Is this some sub-conscious comfort thing among young female interns....or is there some major crime spree going around the hospital? If the thief was foolish enough to steal my bag he'd be sorely disappointed to find a wallet packed full of old receipts, instead of money; a microchip scanner for dogs; and very old mobile phone, due to make its debut on the Antiques Roadshow sometime soon.

One other guy who drew my attention was just wearing the most fantastic outfit. He had a very well-worn pair of tan Cuban heels, boot-cut denims and checked shirt. All topped off with a beautifully cut green wool jacket, a beautifully ornate pocket-watch & chain and the obligatory stetson. When he informed his wife he was going outside for some fresh air, I'm fairly sure he was actually going to check their horses, no doubt tied to a hitching post, out there in the car park somewhere. Wonderfully eccentric, and he pulled it off really well, you couldn't help admire the care that had gone into putting it all together. Really wish I'd had the courage to strike up a conversation with him and his wife, as I'm sure they'd have been just as interesting as their clothing suggested. She had the boot-cut jeans, checked shirt and a neckerchief, and even if they'd sat opposite ends of the waiting room from each other you couldn't help but pair them up.

After an hour and half of not hearing the nurses call my name, I tapped one on the shoulder. "I promise you this isn't a hurry up, as I can see how busy you guys are, but I came in at 2.15pm, and you guys are usually very efficient at calling patients in the the pre-appt weigh-in, so I'm just wondering if my file got missed?" She apologised and went to see where my file could be, and immediately came back, blushing with embarrassment. She had indeed, by mistake put my file on the wrong pile, and they had all totally missed it. The led me straight to the dreaded weighing chair, and we're graceful enough to stay silent as they noted the increase in the last few weeks....I really must get off this *I'm still recovering* trick, and cop on to stopping the slide before it gets away from me!
But, if nothing else, it shows that it pays to know how the system works...or I might well have found myself sitting for many more hours before anyone noticed my misplaced patient file.

The new registrar, who called me within 10 minutes of my visit to the nurses room, seems like a nice guy, and I think we can work well together. He was highly recommended by the nurses, and they know me well enough by now to tell me the truth.
He did initially start off by explaining the bog-standard basics of how the thyroid works, what it does, about TSH, the pituitary gland etc...I let him continue for a minute or two, and when I started finishing sentences for him he laughed, and said "you obviously know all of this already". I replied that whilst I wasn't a doctor, my thyroid had pretty much consumed my life for the past few years, in both literature, education & research, as well as the hard-to-ignore physical symptoms. He seemed genuinely pleased to hear this.
I guess he has to cover all the bases when he sees a patient for the first time, so fair play to him for explaining things in a way that even the most confused patient could follow. Although he was preaching to the converted, I'm delighted that he went to the effort.

He was really pleased with my latest blood results, as indeed he should have been, and when I tentatively suggested that the TSH of 1.1 was pretty much perfect he drew circles around my results, on the page, and said that my current results are exactly what we need to aim for, and then strive to maintain...all in all, so far so good.

He asserted that as far as my height, weight, build etc were concerned he reckoned that my current dose of 150mcg was the right dose to stay on, but obviously regular blood tests, certainly in the early days post-op, would quickly pickup any signs that a dose change may be needed. And also that if I lost significant weight in the future, my dose would likely be reduced (another big positive for losing weight!)

I mentioned the occasional dizzy spells, which are getting less regular, and he said alas that was indeed down to the Eltroxin...but as long as they were only every now and then, there was no need to investigate further. However, if they did escalate, I should go straight to my GP and get it checked out. He explained that in a normal person, with a correctly functioning thyroid, the thyroid levels would naturally rise and fall throughout any 24 hour period, and now that the actions of my thyroid were being replaced wholly by medication, there was no way to naturally mimic the daily peaks and troughs of T4/FT4 demand, only to judge how much I'd need and hope it was distributed as needed...and that is why the occasional dizzy spell is experienced.

And on the same subject, I brought up the suggestion of taking my Eltroxin at night, before I go to bed, instead of messing around in the morning, and having to stay food & drink free for up to an hour after taking my meds...and he categorically said that no, I really should take them in the morning...as one of the peak demand times for T4/FT4 was at the beginning of the day, when you get up and do stuff and need to feel well enough to be active. And by taking the Eltroxin at night, I risked insomnia and sleeplessness from having the full dose of T4 in my system, and then also having it depleted somewhat by the morning when I needed it most. If what he's saying is true, then it makes sense. So for now, until I can find some compelling research articles that say otherwise, I will dutifully follow his instructions, and continue to think about ways of doing it that I will find sustainable for the rest of my life.

We discussed my desire to start a family, and he said that what he would want to see are three consistently good blood test results. My first set of bloods, post-op were 'OK', my latest set were 'Perfect'. If the next set were also 'Perfect' we can discuss it further, but he would prefer to wait for a third 'Perfect' set before giving us a definite green light. Due to the fact that we *will* have further thyroid level complications during pregnancy, so he would prefer us to be as close to perfect as possible, which should make things easier to control when they start going bad again.

And once again, it seems our wedding anniversary weekend will conclude with a visit to hospital.
Regular readers might remember that we got married in a local hospital, as a quirk of our county's civil registration procedure.
Last year we spent the morning of our first wedding anniversary, with me having a CT Scan done - gosh was that only a year ago? It seems that SO much has happened as a result of that CT Scan and the results it yielded. Here I am 11 months later, without a thyroid gland and I feel like that was a lifetime ago.
Our second wedding anniversary will most likely be spent having a long weekend away in the camper van, touring some wild & beautiful part of Ireland, with no fixed agenda...but we'll have to hurry back on the Tuesday, in time for my next Endo appointment on the 31st August. Hospitals and wedding anniversaries really *are* starting to become intrinsically linked, but as long as they are routine appointments, and not visits to A &E, then I'm happy to continue that trend!

Savlon to the rescue!

Oh pants! I seem to have inadvertently removed one of the the (non) dissolving stitches, by absentmindedly scratching at it!

Further investigation, in the mirror, with a torch, shows that there's now a teeny, tiny hole..where no hole should be. So I have drowned it in Savlon antiseptic, and smothered it in Germolene.

Almost six weeks post-op now, and those stitches really should have dissolved by now!

Just one left now, but that one seems determined to stay put, despite all the 'absentminded scratching' I can throw at it!

All the while it stubbornly remains I can't risk using the Bio Oil again...I wish it would hurry up and do something, either dissolve or drop out...

Cute Sunday

*1* is the magic number

Forget *3*, in thyroid-land *1* is the magic number!

For those of us doing battle with our thyroid glands, or in my case now sans thyroid gland, juggling medication levels to emulate our thyroid function, 1 is the magic number. Not all doctors and Endo are aware of this purported holy grail of TSH readings, but so much research and information out there in the real world points to the fact that a TSH of 1 (or as close as dammit) is desirable for optimum well-being.

I've only been near the magic 1 twice since I my first official thyroid blood panel, taken in 2004. The first one was back in July of 2009, with a TSH of 0.65...alas that was a very short lived 'blip', in June '09 my TSH had come back as 4.64, and by August '09 it had dropped to 0.01, firmly back in hyper-land. I can only assume, that somewhere between September '08 and January '09 it also crossed the magic 1.0 threshold, albeit for a day or so, as it swung from 0.03 up to 18.3, well into hypo-land. and most recently, the last time was a month before my thyroidectomy, when the bloods taken on 12th April '10 came back with a TSH of 1.36.

But yesterday, I came back from my GP's surgery staring at a copy of my latest lab results, with a magical 1.1 in the TSH column. FT4 wasn't so bad either at 20.7, just 0.6 above normal ranges...and as explained to me by the kind folks on the Thyroid-Disease Support Forum it was suggested that since I no longer have a thyroid gland at all, a slightly high FT4 is OK, if not desirable. "Barbara" on the T-DSF wrote "when you are on complete [thyroid] replacement you need more T4 because of poor peripheral conversion to T3 in your body tissues. A normal thyroid produces mainly T4 and it also produces a little T3 too but once your thyroid stops working, either by disease or removal, you need extra T4 to compensate."
As I understand it, form the crash course I'm currently undergoing regarding life without a thyroid gland, I need to be aiming for a TSH as close to 1 as possible, and FT4 slightly above range...and if this latest set of bloods are anything to go by, I'm there, right here, right now!

But...and there always has to be a but...only by subsequent blood tests, presumably scheduled within the next 2-4 weeks, will we know for sure if it is all levelling out and reaching some kind of 'perfect' thyroid equilibrium, indicating my bloods are spot on, and in turn, that my medication levels are perfect...or if my TSH will continue to drop (2 weeks ago it was 4.07 (indicating I'm possibly over-medicated) or indeed, bottom out and start to rise again(indicating that I'm under-medicated).

Still lots of hypO cramming to do before I see the NEW Endo on Tuesday, but I feel I'm just starting to get my head around how to lead a gland-less life, and will have some newly-learned armoury to take in with me to my appointment, just in time for the *all-switch* medical staff rotation that takes place in teaching hospitals across the land...

A few articles of interest, regarding 'optimum' TSH...

*Normal* TSH - An article on optimum TSH published by Thyroid Australia Limited

UK Guidelines for the Use of Thyroid Function Tests - go to page 25

TSH, Temperature... - An article by Dr Raymond Peat MA PhD

What is the Optimal TSH Level for Thyroid Patients? - An article by Mary Shomon

And finally, I love the idea of this, and look forward to giving it a go!

Yoga Can Help Thyroid Conditions - an article by Dear Thyroid, posted on Opposing Views


In other news....I would have posted this blog yesterday evening, but I got ghoulishly caught up in the media circus regarding Raoul Moat and the inevitably fatal end-game, and I ended up glued to Sky News until 4am...

News Article: Robots preclude neck incision for thyroid surgery

Original article here: Robots preclude neck incision for thyroid surgery

Robots preclude neck incision for thyroid surgery

AUGUSTA, Ga. - Robots that revolutionized gynecologic and urologic surgery in the past decade now offer the option of removing at least a portion of their diseased thyroid gland without the hallmark neck incision, researchers said.

The thyroid, which sits just under the Adam's apple and controls the body's metabolic rate, is about the size of a kiwi. Benign and cancerous disease can more than double its size. Dr. David Terris, Porubsky professor and chairman of the Medical College of Georgia Department of Otolaryngology-Head and Neck Surgery, has helped shepherd in minimally-invasive approaches that reduced neck incisions from several inches to less than an inch within the last few years.

The daVinci Surgical System, in which surgeons sitting at a console maneuver through tight spaces and around corners, enables access to the thyroid through the armpit, Terris said.

"In my opinion, if you are committed to not having a neck scar, this is the best way to do it," Terris said of patients who are trim, have benign disease and need only half of their two-lobed thyroid gland removed.

He and his colleagues – Dr. F. Christopher Holsinger, associate professor at the University of Texas MD Anderson Cancer Center, and Dr. Ronald B. Kuppersmith, clinical faculty member at Texas A & M Health Science Center – provide an overview of the robotic technique they are helping develop in the United States in the current print edition of Otolaryngologic Clinics of North America.

Although the armpit is farther from the gland than the neck is, simply raising the patient's arm during surgery shortens the path, leaving a fairly straightforward approach made navigable by the three- dimensional visualization and wrist-like maneuverability of the robot.

"The robot is what makes it possible to easily – and safely – do the work from that distance," Terris said. Surgeons gain access through a two-to-three-inch armpit incision, then work their way through skin and fat and finally in between two big neck muscles. "It's a long way down a big tunnel to get to that thyroid through the armpit that would not be possible without telescopes and long instruments," he said.

In the August 2004 edition of Laryngoscope Terris advocated the technique for select patients after comparing five minimally invasive approaches in pigs. While acknowledging that the armpit approach is a lot more work in humans, experience has enabled Terris to complete the procedure in less than two hours vs. under an hour via a three-quarter-inch neck incision.

Korean surgeons have the most experience to date with robotic thyroidectomy in humans and are using the approach to remove both lobes, Terris said, noting that cultural concerns about neck scars helped push Koreans to be pioneers in the field. He thinks improving technology will hasten the procedure's acceptance in the United States, where robotics in other medical procedures are already common.

In the journal article, the thyroid surgeons recommend that colleagues interested in the approach should complete robotics training, practice thyroid removal on cadavers, watch an experienced surgeon use the technique, then have a surgeon watch them.

"I Don't Know"

This morning hasn't gone well so far.

Knowing I was waking early this morning, my intentions for an early night last night were dashed when I found myself still messing around online after midnight...this is getting to be a real pattern with me, and I can't seem to break it. I can't get up in the mornings, and I can't seem to get to bed before 2am at night.

Undeterred I set my alarm an hour before I wanted to get up, so I could swallow my Eltroxin and go back to sleep...so far so good...but then I got tormented by the snooze setting on my alarm. And so my plans of waking serenely and enjoying coffee and breakfast before heading to the doctor for the next round of blood tests, was replaced by a mad panic of realising I was still in bed and needed to be heading out the door in less than 5 minutes...eeeek!

It never seems to go to plan, but the receptionists at the surgery are very discreet, and they almost never comment on my bed hair, or the toothpaste dribbled down my front, so I think I got away with it again.

But I was still firmly in sleep-land during my appointment...I didn't cop that my doctor only took one vial of blood this time, until it was too late, and I was already holding down the cotton wool on the recently violated vein, so she could put in the strip of sticky tape over it. Which means I'll *only* get my thyroid panel done this time...with not a clue of any of my other blood indicators.

I also completely forgot to mention the dizzy spells I've been getting...and when she asked me how I was feeling all I could muster was "I don't know"...which is of absolutely no use to man nor beast! I had it all prepared...what I wanted to discuss with her, the dizziness, the neck stiffness, the *up* days, where I'm raring to go on everything and fit to burst with ideas and activities, and the *down* days, where I couldn't even tell you my name because my head is so foggy....and all I managed to say was "I don't know"....very profound!

I did remember to mention the stitch/infection issue on my scar, which is looking heaps better since I stopped using the Bio Oil, and instead bathed it in Savlon Antiseptic Wound Wash Spray twice a day. And she did have a little dig about with the piece of stitch still evident, but stated there wasn't enough there for her to get hold of and do something with it. She said the dissolving stitches normally take around 4 weeks to dissolve, and if it was still there in 2 weeks time then she would investigate it further for me...I have a horrible feeling that may well involve a dab of local anaesthetic and a scalpel, but I didn't ask. She said to continue with the Savlon Spray if it flared up again...and to stay away from the Bio Oil until she said it was OK to try it again.

Then, to add insult to injury, when I went to pay my fees at reception I realised I had no cash. and there was no cheque book in my handbag. I sheepishly said I'd nip into the nearby village and get some cash out...to find the only shop in the village with a cash machine had it removed 2 weeks ago...so back to the surgery, with an even more sheepish "I'll pop the money in the post"...

Am I still over-exhausted from the stupidly busy, but extremely fun weekend I've just had, or am I in thyroid brain fog hell....you have until Friday to guess, because that's when I'll get today's test results back, and all with be revealed, ha!

My Head Is Spinning

"I don't know what's going on right now. I'm a little foggy, a little dizzy. It's crazy. Crazy!" Robbie Ginepri, American Tennis Player

I know exactly how he feels! I have been getting dizzy spells the last few days, just little ones...but they're becoming more frequent.

My pharmacist warned me about dizzy spells and feeling woozy when I first picked up my script for Eltroxin. She said if I felt a bit weird to head to my GP and get my blood pressure checked, just in case. She claimed that Eltroxin could sometimes cause your blood pressure to plummet, as your body adjusted to it etc.

So I checked my BP at home just now, after my most recent dizzy spell, and its fine (and yes, I have checked the accuracy of my own machine against my doctor's sphygmomanometer). My BP came in at 123/87....at the high end of normal, but not quite into the high-normal range, if that makes sense...but definitely not low, which is what the pharmacist warned me of.

Looking forward to getting my blood tests done again next week, was just discussing with hubby that I *think* I might be going slightly hyper....just a hunch. But the last couple of days I can't sit still, I want to be doing stuff constantly...real ants-in-your-pants, fidgety frustration and anxiousness (without being quite full blown anxiety) to get up and go...do stuff. I'm going to bed stupid late (around 2am) and lying there with my head buzzing to bursting point with thoughts and ideas, because I'm not tired, then up early in the morning raring to go, but with nothing to do, and getting frustrated with that...or with so much to do, but not enough cognitive organisation to get stuck into anything, so I don't know where to start!
I also can't keep a thought in my head for more than 30 seconds, and I imagine trying to hold a sensible conversation with me right now is a total nightmare, as I keep jumping from subject to subject, with no logical train of thought....just blurting things out as they come into my head, because if I don't I'll forget what I was thinking about.

A stitch in time...

...but how much time? How long does it take for dissolving stitches to dissolve?

At either end of my scar I can just about feel what feels like a tiny piece of fishing line. Now I'm sure my surgeon didn't use fishing line, he assured me he'd used dissolving stitches, both internally (obviously!) and externally...and that I could just ignore them, they'll go in time....but how much time.

Hubby kept insisting I was imagining it, we both stared and peered at my scar, but couldn't see anything...but if you brush your finger gently across the scar you can definitely feel the stub end of the aforementioned article, that I'll just call fishing line, one bit at each end of the scar.

So how long until they disappear?

Back to my GP next week for another pre-Endo blood draw, so if they are still in evidence then I'll get her to investigate.

I'm having a mixed response to the Bio Oil. I will of course keep going with it, and I hope that in a few months time I will be absolutely singing its praises to the highest...but my observations for now are both good and bad.

On the one hand, it seems to make the scar sore immediately after I apply it...the soreness is only temporary, and not all *that* sore if I'm honest, but it definitely results in soreness where there was no soreness prior to application. Is this just because the scar is getting direct physical attention for the first time in 3 weeks? Or is the evidence of some possible left-over stitches a sign that I shouldn't be using the oil yet, ie the site is not totally sealed yet?
But on a more positive note, it seems the gentle massage of the area, during application of the oil, gives instant results in improved neck mobility. I find the scar gets tight, and my neck gets stiff, both overnight and as the day wears on, and yet as soon as I've given it some gentle attention with the Bio Oil, the scar feels much less tight and I can turn my neck to the left and right with a lot more ease.

In other news...I finally got the Wii Fit out again, and had an enjoyable 30 minute session on it this morning. I know I mentioned starting again with it a couple of weeks ago, but when the crunch came down I just didn't feel up to it. But I was delighted to find a lot of my regular exercises weren't nearly as difficult or painful as I expected them to be. If anything, I could do most stuff, but obviously took it easier on some of the games. I struggled with anything that involved holding my arms above my head, that really seems to pull on my neck, and some of the more obscure yoga stretches weren't achievable because I was afraid of straining my neck. However I still had a satisfactory session, and worked up a good sweat!

News Article: Nitrates in water and food may increase womens' thyroid cancer risks

Original Article here: Environmental Health News . Org

Authors: Ward, MH, BA Kilfoy, PJ Weyer, KE Anderson, AR Folsom and JR Cerhand. 2010.

Synopsis by Ami Zota, Sc.D

Long-term exposure to nitrates through food and water may increase a woman's risk of thyroid disease, finds a study of older women in Iowa. Public water supplies contaminated with nitrates increased the risk of thyroid cancer in the women. Eating nitrates from certain vegetables was linked to increases in thyroid cancer and hypothyroidism, one type of thyroid disease.

This is the first study to show a link between nitrates and thyroid cancer in people, although nitrates have been shown to cause thyroid tumors in animal studies.

Thyroid cancer is the eighth most common cancer among women. In the United States, the incidence of thyroid cancer has increased steadily since 1980.

Nitrate is a common contaminant of drinking water, particularly in agricultural areas where nitrogen fertilizers are used. High rates of fertilizer application may also increase the natural nitrate levels found in certain vegetables, such as lettuce and root crops.

Researchers from the National Institute of Health studied 21,977 older women in Iowa who had used the same water supply for more than 10 years. They determined cancer incidence using the state health registry. They estimated nitrate intake from public drinking water sources using a public database of nitrate measurements. Dietary intake was measured through questionnaires. Since nitrate levels in private well water were not available, all private well users were combined into one group.

The results show a nearly three-fold increase in thyroid cancer risk for women with more than five year's use of a public water supply that had nitrate levels of 5 milligrams per liter (mg/L) or above. The maximum contaminant level of nitrate in drinking water is currently set at 10 mg/L in the United States. There was no evidence of elevated thyroid cancer risk among private well users.

Women in the highest group of dietary nitrate intake had a three-fold increase in thyroid cancer risk compared to the lowest group of dietary nitrate intake. Thyroid cancer and hypothyroidism risks increased in the women that ate more nitrate-containing vegetables.

Women were exposed to similar levels of nitrate whether they drank from a public water supply or a private well. Higher dietary nitrate levels were found in women who lived in a larger town, were more educated, exercised more and ate more calories and Vitamin C.

In conjunction with prior studies, the researchers suggest the nitrate inhibits the thyroid glands ability to use iodide. Iodine is a necessary mineral for proper thyroid hormone and gland function.

Today...

News Article: New research indicates higher risk for miscarriage in pregnant women with high thyroid hormone level

Original Article: punchng . com

Pregnant women with thyroid function test results in the upper half of the normal range have an increased chance of miscarriage, even when they lack thyroid-harming antibodies, according to a new study. The results, which the authors say show the need to change screening practices for pregnant women, will be presented at The Endocrine Society‘s 92nd Annual Meeting, ENDO 2010, in San Diego on June 22 by Alex Stagnaro-Green, M.D., senior author and senior associate dean for education at The George Washington University School of Medicine and Health Sciences.


Past studies have reported an increased miscarriage rate in women with an underactive thyroid and in women with a positive thyroid peroxidase antibody test, indicating the presence of antibodies directed against the thyroid.


”This study is the first evidence demonstrating that the upper half of the accepted normal range on thyroid function tests is associated with miscarriage in antibody-negative women. This leads us to think that all pregnant women should be screened for thyroid function and any abnormalities treated,” said Dr. Stagnaro-Green.


Thyroid function is measured by the thyroid stimulating hormone (TSH) blood test, and anything above the upper limit is an underactive thyroid, called hypothyroidism. Since 2007, the recommended upper limit of the normal range of the TSH test for a pregnant woman has been 2.5 milli-international units per liter (mIU/L) in the first trimester and 3 mIU/L in the second and third trimesters. This recommendation was made by an Endocrine Society international guideline committee, of which Dr. Stagnaro-Green was a member. However, he said doctors have not universally accepted this guideline, and some use 4.5 or 5 mIU/L for an upper limit, the same as for nonpregnant women. Also, not every pregnant woman receives thyroid function screening.


To see if TSH on the high end of normal affects pregnancy outcomes, the researchers determined the pregnancy loss and preterm delivery rates of women who had TSH values between 2.5 and 5 mIU/L in their first trimester of pregnancy. They conducted the study at two community hospitals in Italy among pregnant outpatients who had a TSH level at or below 5 mIU/L during their first semester.


After excluding patients who had positive thyroid antibody tests, the investigators studied 4,123 women. They divided subjects into two groups based on TSH level (mIU/L): group A: below 2.5, excluding those who had an overactive thyroid, and group B: between 2.5 and 5.


There was no difference in the rate of preterm delivery between the two groups. However, the rate of miscarriage was significantly higher in group B (higher normal TSH) than group A (lower normal TSH): 6.1 percent versus 3.6 percent, respectively.


None of the antibody-negative women in the current study received thyroid hormone treatment. However, Dr. Stagnaro-Green said previous research shows that such treatment lowers the miscarriage rate in antibody-positive women.


[Emphasis in the article, added by me]


Since my thyroidectomy, starting a family has moved higher on my list of priorities. All the while I was hypER, and taking carbimazole, it was all but forbidden by every member of my medical care team. So articles like this are of increased interest for me, and hopefully of interest to others who may be in my position.


Interesting that the article specifically makes mention of the fact that there's still an increased risk, even for those who test within *normal* ranges...and hopefully provides further strength to the argument that many thyroid disease sufferers have with the doctors and endos, in that just being within 'normal' range is not necessarily good enough to be feeling well, and that the suggested target TSH level of 1 or below is becoming more and more important to achieve, and to be recognised by the medical profession in general.

Bio Oil for Scars

Yesterday I was given the all-clear by my surgeon to start using Bio Oil.

Many, many people have recommended it for helping to drastically reduce scarring (as well as improving the appearance of stretch marks and uneven skin tone).

Because he used dissolving stitches, and thus I didn't have to go and physically get my stitches taken out, I wasn't sure when to start using it...and my pharmacist had warned me that because Bio Oil is very thin I mustn't use it until the wound was totally sealed...so I waited until my surgeon said it was OK to use it.

Today is the day. Thanks to my lovely Mum I have a 200ml bottle on hand to get started with. And I reckon Amazon looks pretty competitive, price-wise, for sourcing any subsequent bottles I may purchase.

And here, gore fans (and I reckon its safe now for non-gore fans) is the latest scar pics, taken yesterday, 24 days after my thyroidectomy.


You can find out more info on Bio Oil here: www.bio-oil.com

And here's a link to Bio-oil on Amazon

Farewell to my Surgeon

Went back to hospital today for my post-op follow-up with my surgeon (yes, I know I was only there on Tuesday, to see my Endo - but that's how these guys roll I guess)

I was called in to the consultation room by his registrar, but then Mr S himself came in to have a peer at my neck.

They both stated that they thought it looked good, and was healing very well.

Apparently its perfectly normal to have good days and bad days, with regards to stiffness, pain and the tight feeling...that its all part of the healing process, where its all healing internally at different rates. And it'll probably continue to feel like this for a good while yet.
The remaining swelling was minimal, and the scar site itself they both declared looked excellent.

They reiterated that I need to keep the site protected from the sun at all times. That it will take up to a year before the scar heals completely and becomes strong, but that within a couple of months it should be barely noticeable.

I was given the all clear to start lashing Bio Oil on it, and we all bid a fond farewell to each other as my surgeon declared that as far as he was concerned I was all finished with his ENT department. But, should there be a further complication down the road (highly unlikely), all my Endo had to do was pick up the phone and Mr S would put me straight back on his patient list.

I thanked him profusely for all he had done for me. The more I looked into the horrors others have experienced after Thyroid surgery, the more truly appreciative I had become of my surgeon and his skills. (I did a bit of Google stalking - and have to say he comes extremely well recommended and appears to be very highly respected in his speciality by his peers!).
Post-op I had no numbness, no tingling. No obvious deterioration in my voice or vocal chords (other than initial soreness form being tubed during the op). No problems with my parathyroids, or calcium levels, either temporarily or permanently. And none of the other awful things that are known risks of this type of surgery, which have happened to others, and which my Fuzzy Thyroid Brain won't allow me to recall right now...

Oh, and one more bit of good news...they send a sample of the goitre/thyroid gland for a histology report as standard during the op...and mine came back *BENIGN*. Thyroid Cancer is one of the most common reasons to do a total thyroidectomy, but was never in question in my case. My thyroidectomy was due to my toxic multi nodular goitre, which, in addition to raising merry hell with my thyroid levels, was closing on my windpipe and slowly strangling me....but even so, hearing the word *benign* will surely always give someone a little lift!

Farewell Mr S, you're diamond!

Noooooooo !

Just back from my first Endo appointment since my thyroidectomy. Dragged my long-suffering husband along with me, as I didn't want to risk driving again, so soon after my weekend adventures.

The appointment went well. We've decided to stick with my current level of meds (150 mcg Eltroxin), his argument being that my FT4 is high at the moment, which should hopefully trigger my Pituitary to stop pumping out TSH. He also stated that this soon after the operation my whole system is still under stress, so we don't want to be chopping and changing the meds too hastily at this point, in other words give the dust a chance to settle, to allow us to see more clearly what is going on.

I asked him if I should be abstaining from taking my medication on the morning of future blood tests, or to just keep popping the pills as normal. He mumbled something about 'circadian' as if to himself, then declared that I should take my pills as normal (around 7.30-8.00am) and this would have no bearing on blood tests taken the same morning.

I also explained that I had learned from various sources, about taking the Eltroxin first thing in the morning and not eating or drinking anything for an hour afterwards (especially milk or coffee!). He agreed with this, and asked me how I was coping. He correctly assumed that this was the approach I was taking with the Eltroxin. I explained my morning ritual, of setting an alarm, popping the pills then going back to sleep for an hour...and sadly, he agreed that this was a good way of doing it. I was hoping he'd tell me some other miracle way of getting optimum results from taking these pills, without messing around with my sleep in the morning...but no such luck. maybe once we have my levels better I can slowly start to experiment....I don't want to f*ck around setting alarm clocks an hour before I want to wake for the rest of my life, nor do I want to sit around counting down the minutes to my first cup of coffee!

He asked me to make my next appointment in 3 weeks....yikes! If I have too many blood tests at 3 weekly intervals we're going to have to majorly cut down the food budget to afford them, but hopefully this won't last long, and I can get on to a more financially sustainable blood test interval soon.

And finally, as I headed to the door to make my next appointment with the receptionist, he dropped an absolute bombshell on me. He won't be there in 3 weeks time...in fact he won't be there again....he's transferred to another department!
Nooooooooooooooooooo....just when things were going so well, I really felt we were getting somewhere, and I found an endo who was a delight to work with, a genuinely nice guy, and who didn't treat me like a chart number, who always asked how I was feeling, regardless of the numbers....woe is me :-(

I can only hope that his replacement is even half as good. Watch this space...