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

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

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.

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.

Levothyroxine & Xenical...

...possibly not the best of friends?

After breaking my diet for a few weeks, whilst I had my Total Thyroidectomy, I decided this weekend that I needed to get a handle on my blimp-ness again.

I had planned to drag out the Wii Fit Plus again, and reacquaint myself with the magic blue pills. But something I think I must have read ages ago about hypothyroidism & Xenical was nagging at me from the back of my mind, where I guess I filed the info at the time, so I did a quick Google...and hey presto!

Drug Interactions with Xenical

Drug interactions can occur if you take Xenical with diabetes medications, cyclosporine, or warfarin. When taken together, these interactions can affect the level of medication in your blood and can change the effectiveness of the medication. Tell your healthcare provider about your weight loss program so that you can avoid any drug interaction with Xenical. Your healthcare provider can adjust your dosage and monitor you closely.

Introducing Xenical Drug Interaction

Some of the medications that may interact with Xenical are listed below. Xenical (orlistat can potentially interact with a few other medications. These medicines include the following:

* Diabetes medications

* Cyclosporine (Neoral, Sandimmune, Gengraf)

* Amiodarone (Cordarone)

* Thyroid medications, which include the following:

o Levothyroxine (Unithroid, Levoxyl, Synthroid)

o Thyroid (Nature-Throid, Armour Thyroid)

Thyroid Medications

People who have taken thyroid medications along with Xenical have experienced low thyroid function, better known as hypothyroidism. You should have your healthcare provider monitor your thyroid function while you are taking Xenical, because he or she may need to adjust the dosage of your thyroid medicine.

Moreover, it is highly recommended that you take Xenical and your thyroid medication four hours apart in order to avoid any drug interaction.

More, from the original article, here: Xenical Drug Interactions

And another article...

Xenical's Effect on an Underactive Thyroid

Contributor

By Merrill Gillaspy, eHow Contributing Writer

The diet drug Xenical has been shown to hamper the absorption of hypothyroid medication levothyroxine.

need to diet image by Kimberly Reinick from Fotolia.com

Xenical is a prescription diet medication. Its chemical name is orlistat. Described as a lipase inhibitor, Xenical acts to prevent the body's fat-dissolving enzymes from working, which ultimately interrupts fat absorption through the intestine. Xenical has a range of side effects and contraindications, not the least of which is possible problems for people who have underactive thyroids.

Significance

1. According to the website Netdoctor, Xenical has been developed to act on two key enzymes of the digestive system: gastric and pancreatic lipases. These lipases break down fat molecules in the digestive tract that would otherwise be too large to pass as nutrients from the intestinal wall into the bloodstream. Xenical prevents these lipases from acting on the fat molecules, which remain whole and exit the body as waste.

Function

2. Xenical is prescribed specifically for obese and overweight individuals. The manufacturer recommends its use for people who have a body mass index (BMI) of between 28 and 30 or more. The BMI is a measure of the amount of body fat based on height and weight. A normal BMI is between 18.5 and 24.9. These numbers represent kilograms per square meter.

Cautions

3. Xenical should be used with the utmost caution by people who have kidney disease, diabetes (insulin dose may need adjusting), epilepsy (absorption of antiepileptic drugs may be altered) and hypothyroidism--or underactive thyroid (hypothyroid medication, like levothyroxine, may become less efficacious). Also, contraceptive pills and fat-soluble vitamins, like A, D and E, might not get absorbed as effectively. Consult with your doctor about vitamin supplementation if you are taking Xenical.

Hypothyroidism

4. People on the hypothyroid drug levothyroxine have an underfunctioning thyroid. The thyroid is a gland--shaped like a bow tie--that's located at the front of your throat. The hormones it emits control your body's use of energy. With hypothyroidism comes a low emission of thyroid hormones and decreased energy, in addition to susceptibility to high cholesterol and heart attack. Levothyroxine is sometimes prescribed as a replacement for the hormone your thyroid naturally produces, but people on levothyroxine who seek prescription weight-loss remedies must use caution.

Levothyroxine

5. Xenical has been shown to hamper the absorption of levothyroxine. Consult your doctor if you have hypothyroidism and are taking medication, particularly if you take levothyroxine. Also, should you notice your levothyroxine becoming less effective with the use of Xenical, tell your doctor right away. Most people take levothyroxine for life, which means they must be very cognizant of all the other medications they might ingest. The manufacturer of levothyroxine specifically states that people should not use the drug to treat weight problems.

Read more: Xenical's Effect on an Underactive Thyroid | eHow.co.uk

So I guess I'll hold off on popping the magic blue pills until I've spoken to my GP on Tuesday....but I still plan to spank my Wii Fit Board tomorrow :-)

Some (very) Dark Thyroid Humour...

I guess I'll be avoiding Bok Choy from now on...time to re-read that list of goitrogenic foods!

Back away from the bok choy, ma'am
JoNel Aleccia writes:
Eating extra veggies is a good goal, but an 88-year-old Chinese woman took the quest too far, consuming enough raw bok choy to send herself into a life-threatening, thyroid-induced coma, doctors say.
The woman showed up at a New York emergency room last summer, complaining she couldn't walk or swallow. But the real trouble, according to a report in Wednesday's New England Journal of Medicine, was that she'd been chowing down on 2 to 3 pounds of bok choy every day for several months in hopes of controlling her diabetes.
For those unfamiliar with the vegetable also known as Chinese white cabbage, that's the equivalent of eating two or three large heads a day of the stiff, leafy stalks.

More here:
http://bodyodd.msnbc.msn.com/_news/2010/05/19/4380005-back-away-from-the-bok-choy-maam/from/toolbar

News Article: Irish team to develop better thyroid test

Taken from Irish Health . com

Irish researchers are to develop a more accurate test for thyroid disorders.

The thyroid is a small gland located in the throat. It produces hormones that affect the body's metabolism and energy levels.

Thyroid disorders are common but because symptoms can appear gradually and are similar to the symptoms of other conditions, they are often misdiagnosed. A common thyroid disorder is hypothyroidism (underactive thyroid), the symptoms of which can include weight gain, a lack of energy, dry skin and constipation.

Now, researchers at the Biomedical Diagnostics Institute at Dublin City University and Cork-based company, Audit Diagnostics, are working together to produce a fast, low-cost test for thyroid disorders.

The project, ThyroQuant, is aiming to develop a ‘point-of-care' test, which will allow doctors to diagnose patients accurately in their surgery.

The project is being funded by a €350,000 grant from Enterprise Ireland.

I just hope they can make it 100% reliable and accurate, because anything that speeds up the blood testing & results procedure can only be a good thing...however, it won't address the issues that many, many thyroid disease sufferers have with regards to errors by their doctors (and occasionally endos) in the interpretation of tests, lab ranges and guidance statements.