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 :-)

Hospital food, and TV wars!

[posted retrospectively & not necessarily in order - 1st June, day after the op]

At some point in the afternoon I was moved to a semi-private room, where I shared with another girl. She'd just come back after developing some problems a week after tonsil surgery.
She proceeded to hog the TV remote control, stuck it on mute, then when Desperate Housewives came on later that evening I had to endure it at top volume (when she was discharged the next morning, the very first thing I did was grab the remote control from the side of her bed!)
I was still too tired & spaced to bother with resurrecting any sense of fairness over the TV availability, so I just plugged the iPod into my ears, and watched the moving pictures until Mum and Hubby turned up during visiting hours.

I still wasn't eating very much. I'd forced down a yogurt for breakfast, under great duress from stern-looking nurses. I accepted some soup for lunch, but couldn't get past one mouthful.
Don't get me wrong, I know hospital food doesn't generally have a great reputation world-wide, but I was pleasantly surprised by the variety, tastiness and quality of the hospital food I was given. When my appetite did return I really enjoyed each and every meal. But for now, I just wasn't hungry.

At some point during the morning they emptied the vacuum pump on my surgical chest drain. Overnight it had sucked lots of blood & goo out of me, and I was now becoming more aware of this hose sticking out of the front of my chest. They kept calling it a tube, but it certainly felt like a ruddy great hose! And it was really starting to be a very sore pain-in-the-arse. I had a little clip on the container, so when I went off for walkies ( the nurses were adamant that I should be marching laps of the hospital on a very regular basis - what happened to rest & recuperation?) I could clip the vacuum container-thingy onto my clothing...and thus I could march about, with my lovely container of blood and goo on full public show, hanging off the lapel of my dressing gown...nice!

My surgeon came around at some point in the morning, to tell me how pleased he was about how it had all gone. He apologised for the size of the scar, but said it was as small as he could manage, given the size of the goitre.

Roughly every 6 hours, day & night, a vampire came visiting (different one each time) stealing lots of blood from my poor right arm, and disappearing off with a swish of their cape.
On the strength of these visits I was kept informed of the fact that despite being a Grave's Hyper patient my calcium levels hadn't dipped at all, but that they would continue to monitor them, We all concurred that this can only be due to the sterling work I had been doing with my Endo's Senior Registrar over the last few months, chipping away at my carbimazole dose, ever so slowly, so that for the first time in over 2½ years my blood levels not only come down into range, but had also stayed in range for over 6 weeks. My surgeon had explained to me that the more Hyper I was at the time of the operation, the more my calcium would crash as my body went into instant withdrawal. So thanks to Dr. R and his endless patience and gentle ways, we were pretty much as good as it gets on the day of the operation. But also many thanks to my surgeon, for having a steady hand and not harassing my parathyroid glands whilst he was in there digging about with his scalpel, as that was another common cause of a calcium crash.

Late in the afternoon new girl moved into the bed next door. She was brought in with stomach pains, and put on our ward for observation as there were no beds available on the general wards. We got on great, and came to a mutually beneficial agreement over the TV Remote. She made me laugh so many times, and listened carefully when my mother joined the nurses in nagging me to go walking. She made it her mission to take me off for random walks around the place, as and when she'd decided I'd been laying around too long. If you ever read this, and recognise yourself as that girl, well, thanks J, you were a star!

Meanwhile mum and hubby, when they weren't being doting relatives beside my bed, and listening to my alternating mumbling, croaking & whingeing, were amusing themselves between the 2 shifts of visiting hours, by shopping lots in the local shopping centre and sampling all the muffins in the coffee shops they found!

A friend of mine worked on a neighbouring ward, so she kept me sane too, by popping in whenever she got a chance to make sure I was OK and had everything I needed. She helped break up the long, slow mornings between drug rounds, vampire visits and blood pressure checks. Thanks N, you rock too!

And just for the gore-fans amongst you, here are some pics of my neck and chest drain, taken less than 24 hours after the operation...absolutely no idea what I had to smile about....I was sore, woozy, uncomfortable & grumpy - it must have been a morphine-induced smile, is all I can say! :)

Back Once Again

Seems I disappeared for longer than intended.

We had a weekend away camping, and that was disrupted by an emaciated stray dog who entered my life the day before we were due to leave.

So I've been very busy looking after her (still ongoing - and looking like a long term project) and learning all about greyhounds and greyhound mixes and their specific care needs. (She's approximately half the weight she should be)

She's gained 1.36 kilos in weight already though so I'm pleased with her progress...if only she and I could participate in a little weight swap ha ha! I'd gladly donate all of my spare weight to undernourished dogs!

Still off the smokes, and still giving the scales slightly less to hold up each week, so there are two positives already.

My new meds seem to be OK. They cut my Carbimazole back down to 30mg, and I finally relented on my BP Meds Argument, and consented to starting on Centyl-K, a diuretic. I bought a cheapo blood pressure monitor from my local pharmacy, and I've certainly noticed my BP coming down a little, so hopefully my doctor will concur. Maybe I shouldn't have fought against BP meds for all this time after all...?

The walking has slipped though, and I'm cross with myself for letting that go...need a kick up the bum and the discipline to get out there every morning again!

Pillow Talk

I don't have any trouble getting to sleep, its always been a running joke in my family that I could fall asleep on a clothes line.

But for the last 3 weeks or so I have trouble staying asleep. I wake up constantly, all night long....1am, 2am, 3am, 4am
I drop back to sleep almost immediately...but still seem to wake up on an almost hourly basis.
The longest stretch of uninterrupted sleep I've had in the last 3 weeks or so was *once* when I managed to go from around 2am to 8am...bliss!

This may or may not be thyroid (or thyroid meds) related in my case...but if anyone has come across this before and has any ideas how to restore my sleep pattern I'd be extremely grateful

Cycling, without a bike!

Monthly cycles again, this time an observation....

Been splitting my carbimazole for the last week, half dose in the morning, half dose in the evening - and not noticed any major change in the way I feel....BUT, the hugely maddening (driving me insane) 14-day cycle appears to be on the blink, however, SSSHHHHHHH! Don't tell it, I don't want to wake it up!

So, the way my cycle has been behaving in the last couple of months I should have started in the middle of last week, and currently be in the middle of hell on earth, and be house-bound to all intents and purposes....but I'm not, its late, its nearly a week late (and NO, *that* is not even worth considering, my libido has been through the floor for weeks, it'd be an immaculate conception ha ha!)....
So...is it possible that something as simple as splitting my dose to 12 hour intervals was enough to scare my cycle back into *normality* ??? (yay if its true!)

Does anyone like this theory? Experienced something similar?

Or is it possible that my cycle likes to keep me guessing and is simply changing its own rhythm yet again, ho hum :-(

Quite possibly...

...the scariest day of my life!

Despite a positive diagnosis on my thyroid, my referral to an endocrinologist still hadn't come through. I had been avoiding my GP, and going back to my 'more familiar' Ostrich approach to it all, despite several missed calls and messages to my mobile phone from my GP.

I hadn't filled my prescription for Neomercazole, AKA Carbimazole (CBZ) as money was extremely tight, and I figured it was an unnecessary expense at this time.

I knew I was ill....but sure, hadn't I been ill for years with no medication, and nothing terrible had happened had it?

Well today, was the day I learned that lesson all well and good!

The day started as any other day....tea, cigarettes....more tea, more cigarettes.....some light housework, then onto the computer to see who was up to what in Internet-land...

I had a funny pain in my back, and felt a bit nauseous...but I mostly ignored it. I think I commented on it when J came home on his coffee break...but by the time lunchtime came around I was in a full panic. The back pain was spreadingto the front of my chest, I had pins and needles in my arms, going hot and cold, huge waves of nausea, but not able to actually be sick...but the time J came home for lunch I was in all out panic mode. At this point I had Googled the syptoms for a heart attack, and went into all out hysteria as I read the list and ticked off all the symptoms one by one. My pulse was all over the place, but mostly racing. And as it slowly dawned on me that perhaps this was it, I was finally going to die....I realised I was no where near ready to die...!

J wanted to take me to the GP...I knew that we didn't have the money for an appointment, and for the same reason we couldn't afford to call an ambulance either. I was imploring him to ring our landlord, who works as a paramedic, for some solid advice on what might be going on...but he refused, insisting we went to the GP first. The row over deciding what to do was making me feel worse by the second...and I realised that whatever we did we had to do it quickly, and so we headed to my GP.

She stuck me straight onto her ECG machine...and we were both mighty relieved to see that I hadn't had, nor was I currently having, a heart attack...phew! As far as my heart was concerned all was A-OK. She did various other tests on me, drew several vials of blood from me...and concluded, from the symptoms, that I was most likely duffering from an overdose of thyroid hormone, which may or may not have been dumped suddenly on my system. And if continued unchecked I would shortly go into a full blown thyroid storm, of which two symtpoms immediately jump out at you: coma & death. Either way, she insisted that I had to start to take this seriously, I was a very ill woman and the sooner I copped on to that and started following instructions the better...for me.

You know....we filled that CBZ prescription on the way home, I started my meds that night!

A definite diagnosis...at last!

The cellulitis still wasn't responding to anti-biotics as well as it should, so I was glad to be going back to see the doctor...but there was also a little trepidation as I realised that my blood test results would be available today as well.

I had an ultra painful injection in my bum....seriously, it continued to sting for several hours afterwards, as indeed my doctor warned me it would. But it did finally kick my cellulitis into submission and sent it on its merry way after just a few more days of hot, itchy ankle.

As suspected, my blood test results did show a thyroid abnormality....but surprisingly, despite me having obvious symptoms of weight gain, lethargy, lack of libido etc, the test results showed that I was in fact hypERthyroid, and not hypOthyroid as I had always assumed. We were both a little confused by that, but my doctor had done some research and explained that sometime hypERt patients gain weight inexplicably instead of lose it...I guess I was one of the unlucky ones. In hindsight, I seem to gain weight both when I'm hypo and also when I'm hyper...I just can't win in the weight game.

The tests also showed that my liver function was way out of whack....I was suddenly scared, after watching all the public health announcements and TV adverts regarding binge drinking, thinking that I'd overdone it during my student days, but my doctor immediately put me at ease and said that in the absence of any other symptoms for now we'd put my wonky liver down to my thyroid, and that if the liver function tests didn't improve in subsequent blood tests, THEN we'd look into it all a little more.

A few other test results were marginally out of range, but she reminded me that with my current case of cellulitis my body was presently fighting a huge battle with the incumbent infection. And that for now we should ignore those too.

She told me that she was going to refer me to an endocrinologist, and having previously explained to her the nightmare I'd had with a so-called 'specialist' at a local hospital, she asked me if I would mind travelling a little further, to a hospital in a neighbouring county, in order to see a proper endocrinologist. I jumped at the opportunity, and said I'd go anywhere, as long as she didn't send me back to the ignorant local 'specialist'.

She said she wouldn't initially put me on any anti-thyroid medication as she preferred that to be controlled by the endocrinologist...but if I was waiting too long for an appointment I should return to her and we would discuss starting on anti-thyroid drugs (ATDs). She informed me that when I had received the primary endo appointment to come in a week earlier and get some more blood tests done, so that the endocrinologist would have the most uptodate test results to work from during my initial consultation.

She gave me a copy of last week's blood test results and told me to keep them in a safe place, and to make sure I get copies of all future tests, so that I could contrast and compare as I headed down the thyroid highway. That was the single best piece of advice I've ever been given with regards to my thyroid. She also made sure I was able to read and understand the results sheets, so that in the future I could check my results myself and then phone her and/or my endo to tweak my medication if I felt it was required.

Here are my blood test results from 18-Feb-08

Test

Lab Range

Result

TSH

0.15-3.2

<0.05

Free T3

2.7-7.0

11.6

Free T4

10.3-24.5

29.7

Thyroxine (T3)

58-161

189

(when I've worked out how to set up a proper table I'll edit this and tidy it up!)