Molly b.'s Thyroid FAQ Page 2
14. Q. What symptoms did you experience when you were hyperthyroid?
A. These are not all necessarily thyroid related, but here are the mostly hyperthyroid symptoms that I had...
1. increased pulse, sometimes pounding heartbeat, as if I'd been exerting myself when at rest - especially at bedtime when trying to sleep
2. waking at night, sweating
3. mild exertion caused shortness of breath and racing heart
4. dry eyes and sensations like I had a speck of dust or an eyelash in the eye
5. 'bone tired' - alternating with lots of energy
6. dry itchy skin on backs of hands, often with a painful, nearly bleeding rash
7. less muscle, difficult to open a jar for example, and no stamina - brushing teeth was actually painful, because the arm muscles got weak really quick
8. not very swift mentally - slowed thinking, absentminded and 'feeling dopey'
9. aches in joints and muscles, including difficulty walking up and down stairs, especially in the morning
10. feeling warm sometimes - normally I'm 'always cold' which doesn't fit the typical symptoms
11. some hair loss - for years before weight loss and diagnosis
12. short-tempered, and/or feeling emotionally unbalanced ( someone said it's like having PMS all the time ), panicky feelings for no reason ( anxiety attacks )
13. fingernails growing unusually fast, and much less brittle than before
14. pains in stomach
15. never constipated
16. teenage acne at age 43, with oilier skin and hair
17. insomnia. Difficulty getting to sleep. While I'm not a morning person, I was also waking very early, feeling wide awake, and leaping out of bed, after 5 or 6 hours of sleep, instead of a normal 8 or 9. ( By mid afternoon, I'd be 'burned out' and have to lie down to rest )
18. earaches - maybe no more than usual. My hearing's not all that great sometimes either. I've never got an answer from a doctor as to whether ear/hearing problems might be due to the goiter and cyst
19. pains on side of neck - from the goiter or the cyst, maybe
20. shaky hands - family had noticed these tremors for a long time ( and they never mentioned it - maybe they thought I was a closet alcoholic or something? )
21. overly sensitive to noise - always had this tendency anyway
22. bursts of extreme hunger
23. waking up coughing in the middle of the night and early morning, sometimes
24. a very dry throat during the day - I'd have to have a coffee or soda frequently
25. very rapid weight loss without dietary changes - actually very hungry and eating more
October 1998 These symptoms have disappeared, except for 6) dry skin on hands though it's not as bad as before or as frequent and 23) coughing at night - just once in a while.
January 1999 These last symptoms seem to have stopped as well. The ear aches and pains have subsided a whole lot also.
15. Q. What is a thyroid cyst? How is it treated?
A. A thyroid cyst is a fluid filled nodule ( growth ) on the thyroid gland. A cyst can be drained - aspirated - in the specialist's office, but will sometimes grow again. A cyst is rarely cancerous. It may only require observation over a period of time, for any signs of increase in size, especially if the thyroid gland is functioning normally. Blood tests of thyroid function might also be done occasionally. My sister had a thyroid cyst removed in a surgical procedure, because it was interfering with her breathing, but she had normal thyroid levels. I believe the need for surgery because of this is a very rare occurance. The specialist felt that the cyst I have is part of the multinodular goiter, and doesn't require any further testing or separate treatment.
16. Q. A scan has revealed that I have a single nodule on my thyroid. The word cancer scares me. I'm going to have more tests, but I'd like some information about thyroid cancer.
A. If nodules are working okay they are called 'hot' nodules and are very common. If a nodule shows up on the test as 'cold', or not working right, this might require a small biopsy, usually done in the doctor's office to rule out the possibility of cancer. If the results are unclear or if cancer is present, a nodule would be removed surgically. If the nodule is hot, it will probably not be cancerous, and even a cold nodule doesn't always mean cancer. There is a good chance that you do not have thyroid cancer, since it is rare. Even if cancer is found, the survival rate for the most common type of thyroid cancer is very good, compared to many other types of cancer. Most cases can be treated with very successful results.
17. Q. What is a goiter? Is a toxic goiter a serious problem?
A. A goiter is an enlarged thyroid gland but not a growth on the thyroid. It is possible to have a goiter and normal thyroid functioning. An enlarged thyroid may be present during pregnancy or puberty, and would not necessarily require any treatment.
A nontoxic goiter is an enlarged thyroid which is not over-producing thyroid hormone.
A toxic nodule is a growth on the thyroid which is over-producing thyroid hormone.
A toxic multinodular goiter is an enlarged thyroid which has many overactive nodules that are producing too much thyroid hormone.
The word 'toxic' used in this way is a medical term that just describes the activity of a goiter or nodule. If doctors were to use a word such as 'busy' instead of 'toxic' it wouldn't sound quite so terrible to us patients!
Before table salt was iodized there was a type of goiter commonly found in areas where the soil, and therefore vegetables and fruit, lacked iodine. This is seldom seen in North America today since most of us use regular table salt. Iodine from salt and other foods is used by the thyroid gland to make thyroid hormone.
18. Q. Why is synthetic thyroid hormone replacement prescribed to nearly everyone these days, instead of a natural one?
A. The original medication for hypothyroid patients, desiccated thyroid hormone, was made from dried beef and pork thyroid glands. It was a combination of T3(triiodothyronine) and T4 (levothyroxine).
T3 leaves the body quickly, so truly effective therapy would require taking pills several times a day, to keep the levels in the blood consistent. A person would be hyperthyroid between pills, as the blood levels of T3 rapidly increased and then rapidly decreased from the time of taking one pill until it was time to take the next.
It was discovered that T4 levels in the blood increase very gradually and then decrease very gradually. Pharmaceutical labs developed synthetic thyroid hormone, which uses T4, because T4 is slower acting. No more 'hyperthyroid rushes' as our grandmothers had with desiccated thyroid hormone. The dose per pill is also more accurate because it's chemically manufactured. The amount your body receives daily is important, so most doctors now prescribe the synthetic.
Vegetarians and those who avoid pork in the diet should be especially pleased about this!
19. Q. What is radioactive iodine? Is it the same stuff they give a person who receives cancer treatment ( chemotherapy )? Are there any side effects from RAI?
A. Radio iodine is a substance taken up mostly by the thyroid gland. It damages the thyroid cells so that they can no longer over produce thyroid hormone. Over production of thyroid hormone causes hyperthyroidism. After RAI, the thyroid cells lose their ability to grow and their function is decreased. The treatment has been used for over 50 years.
The radiation is similar to that used during any standard medical or dental x-ray. These, too, are examples of external radiation exposure.
Chemotherapy, used in cancer treatment, is not the same thing. Its purpose, its effects and the side effects are very different from radio iodine therapy.
Because the thyroid gland absorbs all of the RAI, none is taken up into any other parts of the body. Only the thyroid is affected. The radionuclide half-life is 8 days, which means that its presence will be reduced by one-half every 8 days. For the first few days, a person gives off small amounts of radiation - although they don't glow in the dark:) This is why precautions are necessary, such as using your own towels, sleeping alone for a few nights, and not staying within close range of others, especially small children or pregnant women, for more than a few minutes at a time, from 2 to 5 days after treatment. The number of days varies according to the amount you receive. The doctor and lab staff explain precautions and the time involved according to your personal treatment.
RAI can take up to 6 months to work and may require a second treatment. The amount of RAI administered needs to be enough to work on the individual's thyroid gland. Surgery is effective a bit sooner and does have a better chance of success. There's less guesswork involved since the surgeon removes the necessary amount of thyroid gland during the operation. Surgery requires a few days stay in the hospital, so anyone who thinks the precautions necessary with RAI are inconvenient should keep this in mind. RAI is administered in one quick trip to the lab and you are able to go home immediately after with no hospitalization needed.
I had RAI in early December/97 and there haven't been any noticeable side effects - other than no longer being hyperthyroid:) The specialist and lab tech explained that the dose of radiation is not enough to make a person ill, either at the time of treatment, or in later life. I had to stay several feet away from other people - not remain in close contact for more than a few minutes at a time - and use disposable utensils and dishes for 5 days afterward. Laundry had to be done separately from the family's. The sink and toilet had to be rinsed/flushed several times after use.
I was determined to have surgery at first, since my mother had successful surgery in the 1970's, but the specialist said she would like to try RAI because it's non-invasive. I'd prefer effectiveness and not want to base a decision solely on whether or not a treatment is 'non-invasive'! I feel that the high rate of malpractice suits in the U.S. may be a possible reason that RAI is the preferred treatment method in most cases nowadays.
As of September 2011, I'm still on 0.05 mg of Synthroid as I have been since April 1998. TSH test results have all been normal.
20. Q. I had RAI several weeks ago but I feel worse than ever. Everything aches - is this normal?
A. My specialist said muscle aches and pains are common, as muscles begin to build up again after wasting due to the hyperthyroidism. This isn't in the textbooks, but is from her patients reports. Chances are this may occur in some hyperthyroid patients, no matter which treatment is used, as the muscles start to repair themselves.
21. Q. Why do doctors rely so much on the TSH blood test to diagnose thyroid disorders? My friend found a doctor who told her to track her temperature every morning.
A. The TSH ( thyroid stimulating hormone ) was developed a long time after the old basal metabolic rate - BMR and the basal body temperature tests. Like synthetic thyroid hormone replacement, it is an advancement in science.
TSH is especially important when diagnosing primary hypothyroidism ( the most common type ). During the earliest stages, the TSH will always be higher than it should be, while the Total T4 and FreeT4 may be normal. If the T4 is low and the TSH is normal, this is an indication of a problem in the pituitary gland, rather than the thyroid gland. It would be difficult to use the basal metabolic rate or the basal body temperature tests to diagnose these problems early, as is possible with the TSH test. Use of the BMR and the other obsolete tests is a bit like feeling a child's forehead to check for the presence of a fever, instead of using a thermometer. I would be wary of a licensed doctor who relies on any outdated testing for diagnosis and treatment.
In the hands of a competent doctor, the TSH is a reliable indicator of thyroid levels and thyroid function. Just be sure the doctor knows about all the medications you are taking, including any supplements. Sometimes other medications can interfere with test results.
22. Q. I'm looking for some information about hypoparathyroid and hyperparathyroid. My daughter-in-law had a thyroidectomy recently ( I think they also removed her parathyroids ) which upset her calcium balance. She is now on calcium as well as thyroid medication. She has severe heartburn--even worse than heartburn during pregnancy.
A. Although the four parathyroid glands are close to the thyroid gland, neither hypoparathyroid nor hyperparathyroid are thyroid disorders. The parathyroid glands regulate the amount of calcium in the body by producing parathyroid hormone (PTH).
Hypoparathyroidism - low calcium levels, also known as hypocalcemia and high phosphorus levels - or a lessened amount or activity of PTH - is not very common. It may occur after parathyroid surgical removal or when damaged or as a birth defect. The treatment for underproduction of PTH is supplements of both calcium and vitamin D probably for life. ( One other type may apparently require magnesium supplements instead. ) If the parathyroids are bruised or injured during thyroidectomy, calcium and vitamin D may only be needed temporarily.
Pseudo-hypoparathyroidism is a very rare disorder, in which the parathyroids produce PTH but the bones and kidneys do not recognize the hormone.
See The InteliHealth website, for info on hypoparathyroidism here, and EndocrineWebhere.
Hyperparathyroidism is more frequent in women than in men and its incidence increases with age. Many patients are diagnosed while having regular blood tests and have no noticeable symptoms. Symptoms can include loss of appetite, thirst, frequent urination, lethargy, fatigue, muscle weakness, joint pains, constipation, nausea and vomiting, abdominal pain, memory loss, and depression. Hyperparathyroidism can result in osteoporosis, kidney stones or impaired kidney function. Often the result of a benign tumor ( adenoma ) or enlarged parathyroids, surgery is the only safe and effective treatment. There is a 95% cure rate. New advances in surgical techniques have reduced the risks of surgery.
There is some parathyroid information at the National Endocrine and Metabolic Diseases Information Service of the National Institutes of Health.
I think calcium is derived from two different sources and one may have side effects such as heartburn or constipation in itself. I read this somewhere while searching for osteoporosis prevention info. If the heartburn is a continuing problem, she may want to talk to her doctor. While it may seem minor after having gone through a thyroidectomy, the doctor may need this information for appropriate treatment or adjustment of medication.
23. Q. Are there any Thyroid Support organizations?
A. The following organizations are online. You can find reliable thyroid information at these websites. Some of these groups may have chapters in your area.
1. Thyroid Foundation of Canada
2.American Thyroid Association
24. Q. Do animals ever have thyroid problems?
A. Hyperthyroid and hypothyroid conditions can occur in cats and dogs since they have thyroid glands too. Treatment is much the same as for people.
These pages describe symptoms, tests, and treatments for thyroid disorders in animals.
1. Hyperthyroidism is a Danger That Can Strike Your Adult Cat
2. Hypothyroidism Can Slow Down Older Dogs
The site has many interesting articles on pets, beginning at College of Veterinary Medicine, University of Illinois at Urbana Champaign
Have a question? Don't see anything here that relates to it?
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Molly b.