NEWS: Monitoring thyroid hormone therapy is necessary

Original article HERE

Monitoring Thyroid Hormone Therapy Is Necessary - Marilyn Linton

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

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

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

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

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

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

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

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

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

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

New guidelines?

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

The butterfly gland

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

The Thyroid Sourcebook

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

The Thyroid Sourcebook - M. Sara Rosenthal Ph.D

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

News Article: High Security RAI Alert at Customs

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

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

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

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

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

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

News Article: Robots preclude neck incision for thyroid surgery

Original article here: Robots preclude neck incision for thyroid surgery

Robots preclude neck incision for thyroid surgery

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

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

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

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

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

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

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

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

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

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

News Article: 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.

Farewell to my Surgeon

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

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

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

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

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

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

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

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

Farewell Mr S, you're diamond!