NEWS: Thyroid drugs raise fracture risk

Original Article here: Thyroid drugs raise fracture risk

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

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

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

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

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

Tuesday, 07 June 2011

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

One Year On!

One whole year since my Total Thyroidectomy!

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

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

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

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

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

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

*1* is the magic number

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

Original Article here: Environmental Health News . Org

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

Synopsis by Ami Zota, Sc.D

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

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

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

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

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

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

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

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

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

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...

Too Much Too Soon

"Two things are infinite: the universe and human stupidity; and I'm not sure about the universe" - Albert Einstein, Physicist

I was more than a little dumb this weekend.

Cabin fever was driving me up the walls, and buoyed up by my reasonably successful driving adventure on Friday....the opportunity to go camping near the Cork / Limerick border with friends Saturday night was too hard to resist.

And now I'm really sore....simply too much driving, far too soon. The muscles at the side of my neck feel incredibly tight, I can barely move me head, my oesophagus is complaining rudely at even swallowing water, and my chin and throat area are very tender to touch.
Don't even start me on the totally self-inflicted sunburn....I managed to keep the main wound area covered over with a light scarf...but that did nothing to protect my shoulders, which are glowing as I type!

But sure, for views like this, I'll suck up a little extra pain any day!


In other news...I'm still jumping on the scales religiously every Monday morning, even though I'm not currently, consciously dieting (read: eating very badly, if I'm honest!), or really doing any exercise of note...and combined with the fact that I'm currently hypO...I was mystified, and somewhat delighted, to note that I have lost 2lbs in the last 7 days...if only it was this easy when I *am* dieting and exercising properly...

I will not belch the National Anthem

"I will not belch the National Anthem" - Bart Simpson

...but I could if I wanted to!

I don't know if its a direct result of the thyroid surgery. I do not know if its a short-term effect or not, but I am definitely burping more since the operation, and the feeling of pressure relief in my throat & chest immediately afterwards is very satisfying.

Anyone else out there in thyroid blog-land experienced this after thyroid surgery, or is it just me?

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.

Dear Thyroid...

...you're very dear to me!

No, not *my* thyroid, which I'm very glad to see the back of, but the website Dear Thyroid

If you haven't found the Dear Thyroid website yet, please do click the link and check it out.

Dear Thyroid is a thyroid literary support site; written by thyroid patients, for thyroid patients.

The Dear Thyroid, objectives are clear: Support, elevate, create awareness, educate and come together for the greater good, change and wellness.

Dear Thyroid’s Positioning Statement

• Create a community of thyroid patients that feel safe and comfortable writing about their diseases
• Support each other free of judgment
• Create awareness for thyroid diseases and thyroid cancers
• Re-brand the face of thyroid diseases and thyroid cancers
• Local Community Outreach for support
• Resources for thyroid patients
• Become a non-profit to provide thyroid patients with financial resources for prescriptions and other medical expenses
• Hold doctors accountable when improper treatment and negligence takes place

You can read the Dear Thyroid Mission Statement HERE

You can also connect with Dear Thyroid, on Facebook.

Levothyroxine & Xenical...

...possibly not the best of friends?

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

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

Drug Interactions with Xenical

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

Introducing Xenical Drug Interaction

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

* Diabetes medications

* Cyclosporine (Neoral, Sandimmune, Gengraf)

* Amiodarone (Cordarone)

* Thyroid medications, which include the following:

o Levothyroxine (Unithroid, Levoxyl, Synthroid)

o Thyroid (Nature-Throid, Armour Thyroid)

Thyroid Medications

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

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

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

And another article...

Xenical's Effect on an Underactive Thyroid

Contributor

By Merrill Gillaspy, eHow Contributing Writer

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

need to diet image by Kimberly Reinick from Fotolia.com

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

Significance

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

Function

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

Cautions

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

Hypothyroidism

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

Levothyroxine

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

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

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

Some (very) Dark Thyroid Humour...

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

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

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

Light at the end of the toilet-roll tube!

No side-effects from the Eltroxin today!

Hurrah, and long may it continue!

Very impressive!

I ordered two new thyroid books on Amazon last Saturday...and they arrived today! Estimated delivery date was for the 11th !

Really can't complain at service like that. We ordered a shower part on Thursday, to be delivered to our local hardware shop from the depot in Dublin, and that's not expected to land in the shop until Wednesday...

So Amazon can deliver 2 books from their European depot, within 3 days (2 of which were over a weekend) but it takes a shower parts company, located less than 80 miles away from our town, 6 days to deliver a small & eminently 'post-able' part.

Anyway, enough grumbling...the books I ordered were:

The Thyroid Sourcebook - M Sara Rosenthal (to compliment the Thyroid Sourcebook For Women by the same author that I already own)

and

Your Thyroid And How to Keep It Healthy - Barry Durrant-Peatfield (after a glowing recommendation from a close, hypo friend)

Looking forward to getting stuck into both books!

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!

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.

Xenical & Blood tests

Down 2 lbs this week! Which I'm happier with Really do love Xenical!

Back to hospital tomorrow to see my Endo...and hopefully he'll be in a position to tell me more about what's going on. What kind of blocking regime they may have planned for me prior to the op...and most importantly (for me anyway) hopefully he will know roughly how long I'll have to wait now.
My bloods came back last week as slightly hypo, and a bit anaemic....so not sure where that leaves me right now ???