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!

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!

*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...

"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: 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.

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...

Driving Miss Stiffneck

I drove out late this afternoon to collect my blood test results.

This is the first time I've driven since the op...and in hindsight, it was perhaps a little too soon. I still have very little neck mobility, so checking to the left & right at junctions and roundabouts was interesting to say the least. And because I drive ancient old German cars, with no power steering or other modern nonsense, sharp corners and turns were harder work than my neck & shoulders would like them to have been. I have a feeling I'm going to pay for my precocious driving adventures later this evening, and possibly tomorrow too...so, in anticipation of that, whilst I was out I stocked up on extra painkillers too ha ha!

I think I'd have just ploughed right through the middle if I'd had to deal with this set of roundabouts today...



With regards to my blood tests, I was little dismayed to see that I'm slightly hypO. I say dismayed, but lets be realistic...I guess perfect bloods, and the perfect Eltroxin dose, immediately after my thyroidectomy was impossibly optimistic.
My TSH came in at 4.07 (range 0.15-3.2), and my Free T4 came in at 21.8 (range 9.9-20.1). Only marginally hypo really, but with results like that, the labs obviously didn't bother testing the FT3 and T3.
I'm certainly not experiencing any major hypo symptoms, certainly nothing like I've experienced in the past when I've been hypo before...which I'm glad of, because those few months, back in 2009 were truly a living hell!

My Urea levels are above normal for the 2nd month in a row. Definitely something to mention to my Endo next Tuesday. This month they were 8.0 (range 2.5-6.7) and last month they were at 7.1. For the previous 2 years they have consistently been between 4.0 and 6.0 so definitely something I'd like to investigate further. It may just be because I've rediscovered my love for filter coffee, and I'm not being as disciplined regarding my water intake these days.

Delighted to see that my WBC count is higher this month, higher than they've been since almost forever. Up to 7.8 (range 3.9-11.1) from last month's 6.1 my WBC has never been out of lab ranges, but there has been a definite downward trend since I started taking the Carbimazole, something I've been keeping an eye on even if neither my doctor nor my Endo have been too worried about it when I've drawn it to their attention. And I hope that is because I'm no longer taking Carbimazole, a side effect of which for some people is lower WBC counts.

I'm meant to be heading off camping with some friends tomorrow night, but I really am going to have to wait and see how much of a fuss my neck makes after driving today...I hate to admit it, but I may just be trying to do too much too soon :(

Painkillers, Bloodtests & Cinnamon Bagels

Today I'm sore again. My neck / throat hasn't physically hurt for a good while. Its been uncomfortable, its felt awkward, it's nearly always stiff, it generally feels like someone has a good tight, choke-hold around it....but it hasn't been sore. Yet today it is hard to swallow, no, painful to swallow...and ironically, swallowing the painkillers this morning was the hardest thing to do. I almost gave up on lunch completely, and was tempted to make a cup-a-soup instead. Its not sore in a 'sore throat' flu way, but sore as in it felt like I was trying to push food or liquids down past a very solid (and bruised) brick...and occasional stabbing pains in my chin area, and in the left-side of my neck.

I don't know why today should be any different, why I have this throat / neck pain. I have a stupid little theory that my painkillers are working so hard on my period pains - which usually cripple me, to the point of lying on the floor flailing & wailing like I'm in labour, and which are currently barely even making background noise in the pain-stakes - that they aren't working on my neck pain. Highly improbable, but its an explanation which my head is happy to settle with.

Hubby and I headed off to my Doctor this morning (I'm still not able to drive) to get my blood tests done, in anticipation of my Endo appointment next week. The first trip was a wasted effort as she had swapped her Nursing Home Visit from Wednesday to Tuesday, so we went home for an hour or two. I made a Chocolate Biscuit Cake (diet is back on the shelf for another week ), whilst hubby made the most of his morning off from work, and caught up on Top Gear re-runs on the Dave channel. We went back after 11.30 am and it was 2nd time lucky. I explained about today's pain, and how I hadn't had actual pain in my neck since I left hospital, but she reminded me that after a thyroidectomy, my oesophagus was likely to be sore for a surprisingly long time. And that it would most probably continue to remind me occasionally that I wasn't as healed as I thought I was.

I also surprised myself by explaining to her that whilst in general I feel OK, I also feel like I'm still 'treading water', only now instead of waiting for my op, and thus in my head for the rest of my life to begin, I'm now sitting around waiting to start feeling hypO. I was just sitting there in the waiting room, thinking to myself how cold it felt. Then I started looking at the other people sitting there, and wondering if they felt a little cold too, or if it was just me. I almost collapsed with relief when one lady piped up to her neighbour and commented on how cold the waiting room was, given the sunny weather outside! Phew, not just me then! Until that moment I don't think I'd even confessed to myself how much I have been possibly over-analysing every little feeling and trying to fit them into the well-known list of classic hypO symptoms.

We also discussed the info I'd discovered on possibly interactions between Xenical and Levothyroxine / Eltroxin. And she reassured me that she had a few thyroid patients successfully combining Eltroxin and Xenical, showing good weight loss, with no significant impact on the efficacy of the Eltroxin. So once the Chocolate Biscuit Cake is safely eaten up and out of my fridge, I'll consider digging out the magic blue pills again. She reassured me that they would be monitoring my thyroid levels *very* closely over the next few months, and that any dose changes needed, would be picked up very quickly. So now was as good a time as ever to start back on the Xenical, if I wanted to do so. But she did also say that if I didn't feel ready to knuckle down on the diet again, and wanted more recovery time, to make my own judgement as to when to start back on the diet pills again. She knows, as well as any of us girls do, that sometimes, when you're feeling low, or in pain, or just a little sorry for yourself...chocolate *IS* the only remedy! :)
(And chocolate is most certainly *NOT* an option when you're taking Xenical!)

In other news...is there a world shortage of Cinnamon Bagels, or is it just localised to my town? I'm hooked on them...but my long suffering husband took me from shop to shop searching for them, and in the end I had to settle for 'fruit loaf' instead....and there is just NO comparison.

Out with the Old

My Post-Surgery appointment letters for both my Endo and my Surgeon turned up in the mail yesterday, I'm back to see them on the 22nd & 24th of this month respectively.

And so I've pencilled in this coming Tuesday with my husband to go and visit my GP, and get my bloods drawn. (I still can't drive after the op, so he needs to take me wherever I want to go)

And it occurred to me that this next set of blood tests signified the dawn of a new era for me....my first set of bloods sans thyroid gland...and so my blood tests slate is effectively wiped clean, and we're starting all over again.

So, just to allow me to mourn the passing of all my old lab tests, here, for one last time are my most up-to-date lab graphs...

[the FT4 range 'wobble' is where the labs changed their testing technique,
and thus the ranges changed]

Looking forward to making new graphs, with my new results, in my new life :)
If nothing else, because they give my Endo a good chuckle - he loves them, and loves to show them around to his med students ha ha!
But also because *I* find them interesting, even if no-one else does!

Uh oh - New Meds Blues

Took my first dose of Eltroxin this morning...and it went straight through me :(

Checked the data sheet, and sure enough diarrhoea and stomach cramps are listed as a side-effect.

99% sure that its the Eltroxin...as my other meds haven't changed at all in the last 5 days.

I guess only time will tell. At the end of the day, now that I'm technically hypothyroid, there aren't too many options for medication...so my body is just going to have to suck it up princess!

Other than that...I guess I feel OK. Still wiped out, wobbly & tired....but SO nice to sleep in my own bed last night.
Although I still found myself waking up at 2am waiting for my bloods to be taken, waking up at 4am for my blood pressure to be checked, 6am for the drugs trolley, and was most surprised that my surgeon was a "no-show" in my bedroom at 8am...although, if he had turned up, my husband would have been incredibly surprised! Ha ha!

I'm Free!

Yes!

They let me come home today!

My calcium levels stayed where they should, and showed no sign of going all crazy on us. And all in all, my surgeon was very happy with everything.

My chest drain came out yesterday...which was on the one hand, a total relief, from the increasing pain & discomfort it was causing me, but also a truly unpleasant experience at the same time. It works as a vacuum, and even though the nurse was as gentle as she could be when she was removing it, you could still feel the pipe desperately trying to suck you inside out as it was pulled through the hole in my chest.
It was also touch-and-go as to whether they would remove it at all. Apparently my surgeon doesn't like it removed until the previous 24-hrs have yielded a specified minimum amount of blood & goo, and the nurses had already informed me that when they'd emptied & measured that morning I was still producing too much blood & goo. But he also doesn't like to leave them in longer than 48 hours if he can help it...and so I pleaded with him, and he gave the nod to the accompanying nurse on his rounds that morning! Woo!
So I was left with a sore hole in my chest, covered by a nice white dressing...that continues to absorb all the goo that continues to ooze out, and swells up to bursting point - really very clever. A normal plaster just can't compare!
And I don't care, because I no longer have a rigid fire hose sticking out of my chest, causing huge pain whenever it moves by even the merest minuscule amount...and I no longer had to march around the hospital with a transparent tub of blood & goo clipped fashionably onto the lapel of my dressing gown - happy days!

And now I'm home. I'm wrecked, I'm wobbly, I spent most of the afternoon back in bed, and I feel (and look) like I've been hit by a truck....but I don't care, I can do all that in the comfort of my own home...without nurses telling me to eat more, to walk more, to generally do more of everything that I didn't want to do, and all that other nursey-stuff.

I have to say, on behalf of my poor, drained right arm, I'm home just in time...those poor veins have had a real hammering since Monday (4+ blood draws each day), and the Junior Doctor who came to do my last set of bloods last night did a truly amazing job of drawing blood from the side of my wrist, after we both scratched our heads for a while, watching all the conventional blood-draw veins wave their own little white flags of defeat and proceeded to bury themselves deeper, one after another, no matter what he tried.

But all that is behind me now...I'm home, I'm home, I'm home!!

And now I start my new life, without the help (or should that be hindrance?) of my thyroid gland!

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! :)

Sleep, At Last

[posted retrospectively]

I don't remember being taken up to the ward from the Recovery Room...no that's a lie, I *vaguely* remember being wheeled somewhere, and muttering about travel sickness.

Then I remember my mother and the Ward Sister working as a team to get me off the trolley and on to the hospital bed. More bright lights, more 'wake up and talk to us' torture.

Lots of unplugging and plugging in of various things attached to my body.

I tried to keep my eyes shut as much as I was allowed, those lights really were bright, and seemed to be directly in my line of sight!

The automatic blood pressure machine was permanently attached to my right arm and seemed to blow itself up every 5 minutes. I had a mask, feeding me lovely oxygen, strapped on my face and just lay there, allowing all these busy folks do all their busy things to me.
I don't know how long hubby and mum stayed with me, but I know they were there for a good while. I can't imagine I was very good company though.
And I do recall Jon going off downstairs to the smoking area for a cigarette, and contacting Mum because the Security Nazis wouldn't let him back up to the ward.
And even when the Ward Sister contacted them directly to allow him up they still refused, and made him sit in the Main Reception Area and wait until *official visiting hours*.
What a pair of utter, utter bastards...and I make absolutely NO apologies for my language.
His wife is up there, having just come up from the Recovery Room after a major op, where she was held longer than normal due to a complication (which hasn't been fully explained to me yet). He's worried sick, and even the dictat of the Ward Sister herself isn't enough for this pair of gob-shite jobsworths to let my husband *back* up to the ward, where he's been ALL DAY LONG! Rant over - but I remember at the time I was distressed because he wasn't there, and the more I think about it, now that I know the facts, the more angry it makes me! Totally unnecessary!

I woke up in the middle of the night, needing a pee, and not knowing how to go about it. I wasn't confident about getting out of bed, added to that all the wires, and tubes had me fixed to the bed in some weird cat's cradle set-up. I couldn't find a call-bell, and so I waited patiently until I spied some nurses, and proceeded to croak at them as best I could...more than a little confused that 'croaking' was the best I could muster. I did succeed in getting their attention and they found my call-bell (it had fallen off the side of the bed) and we formulated a plan to get me up and over to the bathroom. Once I was free(-er) from my tubes & wires, I sat up and swung my legs out....which caught them both by surprise, then I stood up and they both looked a little shocked. Then I sat back down again, fast, before I fell down.....major head swim! We went back to the well formulated plan, and I was soon shuffling towards the bathroom door for a well- earned pee.
Then I shuffled back again, but had a mini panic attack just as I got back to the bed, as I had literally run out of breath, and couldn't breathe....now that was scary. I remember looking at them wide-eyed, and they placed me back in bed, and soon had that lovely oxygen mask on my face again....aaaaah!
Once my breathing had settled and my oxygen levels had improved, they dragged me out of bed again. I was still in my theatre scrubs, and we all agreed that if I could possibly manage to get into my pyjamas than I would a hundred times more comfortable. We picked out what I would wear, and then I stood there feeling utterly helpless, whilst they removed the sexy back-less gown, the sex-kitten disposable knickers and replaced them with much less exotic cotton knickers and comfy pyjamas...I was allowed (told) to keep the sexy surgical stockings on.
Then back to bed, where I was not only *allowed* to go to sleep, it was positively encouraged this time!
At some point, later that night, a vampire came in and drained my right arm of blood..at least I think that's what happened. The vampire was good enough to put a plaster on it afterwards though.

Just Let Me Sleep

[Again, posted retrospectively, as I was in absolutely no fit condition to post on the day]

OMFG! That has to be one of the worst 24-hours in my life.

This update has the potential to be very long, so grab a cuppa and make yourself comfortable...

...are we sitting comfortably, then we'll begin.

Yesterday was the day of my Total Thyroidectomy. We arrived at the hospital at a sprightly 8am, and reported to the Admissions Office. I'd been fasting from 10pm the night before, and hubby and mum had been great in the morning, skipping breakfast out of sympathy and trying to drink their tea/coffee as discreetly as they could (bless!). As we drove past the petrol station with the *best* coffee machine in the whole wide world, hubby very cleverly distracted me with some inane conversation, and continued on the journey to hospital.

The ladies in Admissions gave me my file and sent me up to my ward, where I was greeted by the sister...and instructed to loiter near the nurses station and await further instructions.
First was a quick interview with my surgeon's registrar, he drew blood for testing, and filled out some forms.
Then sister came and asked me the same questions, and quite possibly filled out identical forms.
There was no bed presently available...and so we were given the ward sister's office as our temporary HQ...that's when it all started feeling a little surreal. However I was assured my op would be done shortly, and there would be a bed available when I came back up from the Recovery Room.
The next interview was with my anaesthetist...and I have to say she was absolutely lovely! She answered all my stupid questions with confidence and more than a little humour and humility. For me the biggest fear has NEVER been the operation itself, I have been looking forward to getting that gland removed...my biggest fear has ALWAYS been the general anaesthetic....I guess I've watched too many hospital dramas and hospital horror films....and when I asked her if I would wake up, she beamed and said " yes of course, I guarantee it 100%". She must have been a little confused by my look of complete horror, and then understanding dawned on her, when in my small (now shaky) voice I continued "...during the operation"....she laughed, held my hand, and again said "I absolutely 100% guarantee that you will not wake until I allow it"
I was brutally honest about my smoking, and the fact that I had tried and totally failed to give up prior to the operation...but she said that whilst it did make things a little more difficult for her, it certainly didn't make it impossible and wasn't really that much of an issue. She constantly reassured me that she didn't foresee any complications at all. She filled a few more forms out, and then told me she'd see me in the theatre.
Sister bustled back in to the office and informed me that I'd go down to the theatre within the next hour and a half, but first I had to go and get an ECG....this would help the anaesthetics team get a good picture of my heart, immediately prior to the op. So off we trotted, and got hopelessly lost...I'd always gone up to the ECG rooms from the Outpatient's Dept in the past, and approaching it from a different direction threw me completely and I lost my bearings.
ECG done, and all looking good (or so I was told anyway) we trotted back up to the ward.
I was dying for a pee at this point, and hunted around the ward for a loo....aaaaaah!
Then literally, 2 mins after I'd visited the loo, Sister came in and asked me for a sample....but I've only just been!?
Sister said I'd be going down to theatre in an hour, but I had one more little mission to attend to...I had to go to the X-Ray Dept this time, and get a Chest X-Ray (an extra job because I was a smoker I guess). Sister suggested we go for a walk, and see if I could work up a pee sample that way. The chest x-ray was totally clear, which is always nice to hear when you're a smoker. And so we went for a bimble around the hospital. Mum and hubby by this time were flaking from not eating breakfast, so I conceded to let them go to the coffee shop, where they could scoff muffins and cappuccinos...whilst I nipped out to the smoking area (bad girl!). We were sitting around whilst they finished their coffee & cake, and thinking just *how* surreal this all was. Here I was, sitting in the coffee shop, fully dressed...and meant to be being wheeled in for a major operation in less than an hour...?
One more smoke, and then we headed back up to the ward. Sister asked if I'd managed to pee yet...but no such luck. She said I had half an hour to produce, or they'd bump me down the theatre list...talk about putting someone under pressure, and considering I'd been fasting completely (no food or drink) for the last 12+ hours, where was this pee meant to manifest from?
She told me that the pee sample was compulsory to test for pregnancy, and that without it they wouldn't go ahead.
I have an abiding memory of sitting in one of the loos, tears of frustration pouring down my face, pleading with my kidneys to do something, anything, anything at all...because otherwise all this would be for nothing, and if my bladder held out much longer I'd be sent home and bumped to the next day. I should add that Sister did apologise unreservedly for not giving me the sample pot as soon as I appeared on the ward that morning, as is her normal pre-op routine, but we caught her on the hop and she totally forgot...but that didn't change facts...if I didn't pee, I didn't get my trip to theatre.
Then joy of joys....the tiniest of dribbles....but Sister had assured me that even the smallest sample would be sufficient, I just had to hope this tiny dribble wasn't too small, as the thought of going through all the trauma of trying to pee again was too much!
Phew - she rewarded my efforts by giving me a sexy, back-less theatre gown to wear, along with some sex-kitten disposable knickers and a pair surgical stockings to die for (I've brought the stockings home with me - my hubby is a very lucky man!)
And then, dressed for a killer night on the town, we sat in a holding room...where Sister, tongue-in-cheek, asked my Mum if she had provided the sample for me, out of desperation. We all laughed and that helped break the tension that was now building inside me.
Sister explained that I had been moved down the list, but only by one place, and only because of the delay in providing my pee...but that the lady who had moved up in front of me was only having a small procedure done, and would be very quick. And so we waited.

But all too quickly it was time to go. I had hoped for a trolley or something, but no, Sister insisted I could walk just fine...and so, in my best theatre outfit, with my arse hanging out the back, we all trooped down to the theatres...hubby walking shotgun, and mum walking as close behind me as she could, without looking like a complete weirdo ha ha!

The would only let one relative into the Pre-Op Staging Area, and so mum came in with me...and finally I was given a bed/trolley to sit on, with a big fluffy duvet. A troop of various medical staff came along, with various (curiously identical) forms to be completed. A nice young man came u and introduced himself as my anaesthetist, and I think I confused the hell out of him when I told him that he wasn't the lady I met earlier...then he laughed and said she was his partner, and they worked in pairs.
My surgeon also paid us a quick visit. I almost didn't recognise him in his scrubs, I had only ever seen him previously in his suit etc. He talked through the procedure again, and reminded me of the potential problems, and also of the low statistical probabilities etc, etc, and then said if I was good-to-go he'd see me in there shortly.

We were given magazines to read, a stack of OK, and Hello, and I was dismayed to see the young lad in the bed next to me was given a copy of the latest Irish Vintage Scene...which he clearly didn't want to read. So when the nurse had disappeared I suggested a swap. Strangely he didn't want to read OK or Hello, but he did pass IVS over to me, so I could lose myself in lovely Vintage Cars whilst I waited for my call to theatre.

And soon enough, I was collected up and wheeled off down the corridor into the theatre itself. I had to shuffle myself over from the trolley and onto the operating table myself, which was more than a little surreal and most undignified, trying to hide my butt from all and sundry as I wriggled across...and when everyone trooped into introduce themselves I did ask them if they had forgotten something. They looked at me blankly, and so I asked them whether I was...erm...meant to be asleep right now...just in case they needed the fact that I was still wide awake and fully conscious made aware to them. Then my lovely lady anaesthetist walked in and said, "no, that's what I'm here for".
She gently laid my left arm on a sticky-outy panel (I just *know* that's the technical term for it!) and carefully put the cannula in. Various members of staff talked some inane chatter to me, and the last thing I remember is one of the theatre nurses holding my right hand and asking me how I coped walking 6 dogs....I remember feeling a bit frustrated because the words I wanted to use to answer her wouldn't come out...and then nothing...

...until those evil, nasty people in the Recovery Room started up with their Prisoner Of War Torture Techniques....you know the bright lights, the sleep deprivation, and shouting, lots of shouting...everything was so bright, and they all seemed so loud....but they got extra excited and extra loud every time I tried to close my eyes against the bright lights. I'm fairly sure I was rude to them, and more than once, as 'sod off' didn't seem to be working, so I had to reach into my head for much stronger ways of expressing myself. And all the inane questions they kept asking, over and over again....do you know who you are, do know what day it is, do you know where you are, do you know why you're here, will you open your eyes, keep them open, no you can't sleep, we won't let you, yada yada yada.....just leave me alone, I'm very tired and I want to sleep!

My last...

...Endo appointment before my thyroidectomy!

And bless him, he did make me laugh.

He reassured me that my current bloods looked as good as we could get them. And we indulged in a little mutual appreciation, and some metaphorical back-slapping as we congratulated ourselves on working so well together over the last few months, to get my bloods as good as we damn well could prior to the operation. To re-cap...all my levels have stayed within range for 2 months now...something we have until now totally failed to achieve since February 2008. Up until now, the *only* time my levels were' normal was during a 'snapshot' blood test taken whilst I was swinging from HypER to HypO or vice versa. So for 2 concurrent monthly tests to be within range is a momentous occasion for me!

I have to say, it has made a HUGE difference in my care to be able to see the same Endo each time I go in. In the very early days of my Endo referral I was bumped from Intern to fresh-faced Intern...and whilst some of them were absolutely on the button with their knowledge and destined to be brilliant in their future Endo careers, all too often I felt I was holding the hands of the less-experienced ones during my appointments, and having to help them along with ideas & suggestions. The fact that I'm such a regular in the Endo clinic now, that I can request (and receive) appointments exclusively with the Senior Registrar each & every time has made a big difference, and the fact that he and I get on so well together is a complete bonus!

He promised me that if there were any 'endo' issues during my stay in hospital next week that they would of course contact him in the first instance. And that if I was truly worried I should get a permanent marker pen and write "If in doubt contact Doctor Xxxxxxx on Bleep # xxx before cutting!" on my chest! Ha ha!


Edited to add: In a nod to this blog entry: CT Scan & Wedding Anniversaries , yes...my 2nd wedding anniversary will indeed be spent in hospital, attending my Endo...so at least there's no need for me to try and have an accident or something like that - just kidding! I got my hospital anniversary wish, without trying!

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.

Grrrrr...Endo Woes!

Well the Endo appointment was mostly a total waste of time, diesel & effort

Both my Endo consultant and his senior registrar were out on leave, and their stand-in was an obnoxious prat, with no clue of my medical history, no clue of my medical future, and absolutely no interest in either...and who proceeded to ignore my blood results and talk *at* me for 20 minutes, holding forth as if he was the almighty righteous who dare not be questioned on anything...after 19 minutes I finally gave up and stopped disagreeing with him *LOL*

However, the nurses were delighted (for once!) with my pre-appointment weigh-in...and also confirmed my operation should be within the next 3 months.

Today's weigh-in...mixed emotions, but mostly positive.
The bad news is that I'm *UP* 2lbs this week....but the good news is that I expected more, so I am actually pleased that the damage is *only* 2lbs...there is logic there, I promise....bear with me.

Whilst I spanked the Wii Fit Plus this week like a mo'fo'....doubling my daily workouts are really pushing myself....I did also have the food weekend from hell (or heaven, depending on your view point ) and knowing this, I committed the unspeakable, cardinal sin of going off the Xenical pills from Thursday lunchtime in preparation so I could eat badly with no 'tango' concerns all weekend ...and combined with the fact that I'm smack bang in TOTM territory....I hope you can see how I would be pleased with *only* a 2lb gain. I think I'm totally indebted to Wii Fit Plus for sparing me utter mortification on the scales this morning

The line was drawn last night, and I'm back on the Xenical, and back on track this morning....that 2lb will be history this time next week

Next Endo appt is in 1 month...assuming I haven't been admitted for surgery before then.