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Thyroid Flyer V1 No2 Thyroid Flyer V1 No2 Document Transcript

  • Inside Page FEATURE: Treatment of Graves’ Hyperthyroidism 1 Thyroid NEW: Thyroid Eye Disease Hyperthyroidism Over To You (Members’ Stories) Telephone Contacts 3 6 4 7 A Funny Little Story 2 Flyer A Plea to Endocronologists Upcoming Meetings Know Your TSH Recommended Web Sites 5 5 7 8 Newsletter of Thyroid Australia Volume 1 No 2 April 2000 Feature - Hyperthyroidism and TED Treatment of Graves’ Hyperthyroidism The Australian Way By Peter Colman P eople who try to research the reduce the amount of functioning thy- terstate clearly treatment practices do treatment of Graves’ disease roid tissue and hence reduce thyroid differ considerably. Does this matter? on the Internet or via medical hormone production. Probably not. books often end up confused rather In 1996 a group from Stockholm, The same trial mentioned above, than informed. Part of the confusion Sweden published a report in the Jour- which included 179 patients with flows from the fact that approaches nal of Clinical Endocrinology and Graves’ disease, compared each of the to treatment differ quite dramatically Metabolism which highlighted the three treatments and found that they within and between countries. variation in treatment of Graves’ dis- were equally effective in normalizing There is universal agreement that ease between countries. These re- thyroid hormone levels within 6 people presenting with Graves’ dis- searchers circulated the case of a weeks. More importantly, after treat- ease require rapid treatment to settle ‘typical’ patient with Graves’ disease ment, 95% of patients were satisfied the symptoms, which are often inca- - a 43-year-old woman with moder- with the treatment they had received. pacitating. However, this can be ate hyperthyroidism and a diffuse goi- So how should we choose what achieved by tablets, by surgery or by tre - to specialists in USA, Europe and treatment is the right one for a person radioactive iodine treatment. Japan. The results were surprising. with thyrotoxicosis? The treatment The tablets fall into two groups, The first choice of treatment offered choice should be made on the basis β blockers (such as Inderal) and anti- by thyroid specialists in the USA was of many factors such as age, severity thyroid drugs (such as carbimazole or anti-thyroid drugs (30%), surgery of symptoms and most importantly propylthiouracil). The β blockers (1%) and radioactive iodine (69%); wishes of the patient. With Graves’ block some of the most troublesome the corresponding figures among spe- disease there is a 50% chance that a symptoms of thyrotoxicosis - shakes, cialists in Europe were 77% (anti-thy- course of tablet treatment (for 12 to sweating, rapid heart beat - by block- roid drugs), 1% (surgery) and 22% 18 months) will permanently cure the ing the effects of the excessive thy- (radioactive iodine), respectively. The condition. For this reason most doc- roid hormone on the muscles, skin figures for patients with typical, mod- tors will advocate trying the tablets and heart. However, β blockers have erate and uncomplicated Graves’ dis- first. In people in whom the tablets no effect whatsoever on reducing the ease in Japan were 88% (anti-thyroid control the condition but there is then excessive production of thyroid hor- drugs), 1% (surgery) and 11% (radio- a recurrence, surgery or radioactive mone from the thyroid gland. The active iodine), respectively. Factors iodine treatment is usually advised. anti-thyroid drugs, on the other hand, taken into consideration included the Overall, the most important thing work on the thyroid directly to de- patient’s age and preference, severity for you to do is to discuss the treat- crease the excessive thyroid hormone of disease and glandular size. How- ment alternatives with your doctor production. These tablets often take ever, it is obvious that local traditions and if you are not sure .... Ask! a few weeks to produce effects and and available treatment resources are often need to be used in quite high probably the most important factors Associate Professor Peter Colman is dosage, at least initially. guiding the choice of treatment. Director, Department of Diabetes and The other treatments, surgery and Similar figures for Australia are Endocrinology, Royal Melbourne radioactive iodine, are grouped to- not known. However, from talking to Hospital gether as ‘ablative’ treatments. Both my colleagues in Melbourne and in-
  • Editorial Zoo Picnic and Launch Just over twenty people joined the Herald Sun, the Geelong Advertiser, the Melbourne put on a beautiful sum- Committee for a picnic, including many Bendigo Advertiser, the Maroondah Jour- mer’s day on Sunday 13 February for the new members and some who joined on nal, and ABC Radio. As well we had ar- national launch of Thyroid Australia at the day, as well as partners and family ticles with photos in the Yarra Leader, the Melbourne Zoo. Near our picnic site, members. We were particularly happy to the Monash Journal and the Waveley Ga- you could hear the lions roaring and there welcome Professor Peter Colman of the zette. Several of the free community were hundreds of people wandering Royal Melbourne Hospital. newspapers around Melbourne included around. A special attraction was Yakini, Our organisation was launched offi- notices of the launch and we were also the baby gorilla just a few months old. cially by Dr John Ross MLC, Victorian mentioned on community radio. Why did we pick the zoo? The Mel- Legislative Council Member for This publicity has caused our contact bourne Zoo is famous for its butterfly Higginbotham. Dr Ross is on several statistics and membership to increase dra- house - a temperature and humidity con- Opposition committees on health and re- matically. We now have close to 100 trolled tropical room through which you lated issues. We thank him for his time, members throughout Victoria and else- can walk and have colourful, exotic but- and for all his good words about Thyroid where. We look forward to having our terflies fly around and rest on you. And Australia and the work we are doing. first regional support meeting in Geelong of course the Ulysses butterfly is the logo A special presentation was also made shortly and hopefully other regional cen- for Thyroid Australia, representing that to Stephanie Mawson who has set up the tres will follow. butterfly shaped gland in our necks that Thyroid Australia website. By Christopher McDermott has, in one way or another, drawn us to- The launch was also a terrific vehicle gether to form this support group. to attract publicity for the organisation. Thyroid Australia Web Site We received coverage in The Age, The We are very excited that Thyroid Aus- tralia now has its own web site at http:// www.thyroid.org.au. We thank the Chronic Illness Alliance for hosting our site, and particularly Dr Christine Walker.. Our thanks too to Stephanie Mawson for all her work in getting the site up and running. We look forward to your comments and suggestions about the site. Support Meeting We held the first of our support meet- ings at the Royal Women’s Hospital on Saturday 18 March. We had a good turn- up of members (and others) and a lively discussion over coffee and biscuits. One member said afterwards that she had learnt more about her thyroid condition that afternoon than she had in the years since her diagnosis! The launch of Thyroid Australia at the Zoo with Dr John Ross MLC (Front Right Continued Page 3 Centre) and Prof Peter Colman (Centre Rear) A Funny Little Story By A Graves’ Patient Well, as you all know being diagnosed with a disease that is ‘for life’, can get pretty damn depressing. So here’s a funny little story to cheer you up. Recently I called in to see a friend of mine. She owns a little cat called Crystal. I must confess that the last time I saw Crystal, I thought she was on her last legs. She looked terrible, her fur felt rough and dry to my touch, and she was so skinny and bony when I patted her, I thought I’d probably never see her again. However, on my next visit, to my surprise she was still alive. My friend explained they had taken her to the vet, who diagnosed her with an overactive thyroid gland. Yes, she had Graves’ disease, which helped explain why she was always so hungry, but never put on any weight. “Oh, you poor little thing, I know just how you feel,” I said. Her owner told me that she was taking Neomercazole or Carbimazole, the very same tablets I had been taking too! I was talking about the cat with another person who also has Graves’ disease, and he said, “Oh, and did she have shaky paws too?” With that, we both roared with laughter. 2 Thyroid Flyer Volume 1 Number 2 April 2000 Thyroid Australia
  • Editorial from Page 2 Russian Material on the Internet Thyroid Eye Disease Dr Valentin Fadeyev at the Moscow By Anthony J H Hall Medical Academy has alerted us to a Rus- sian web site dedicated to thyroid disor- What is thyroid eye disease? ders (over half of it for patients). The URL Thyroid eye disease is an auto-immune disease of the orbit (eye socket) and eye is http://thyronet.rusmedserv.com . muscles that occurs in people with thyroid disease. It is characterised by inflamma- Cyrillic language software is needed to tion, swelling and eventual scarring. acess the material properly. Congratula- Who gets thyroid eye disease? tions to the team in Moscow who put it Thyroid eye disease is most commonly seen in people with Graves’ disease (hyper- all together! thyroidism) but it can also occur with hypothyroidism, Hashimoto’s thyroiditis, and Young People With Chronic thyroid cancer. About 40% of people with Graves’ disease will develop thyroid eye Illnesses disease. Most cases of thyroid eye disease develop shortly before, or soon after the On 1 February, the newly formed diagnosis of hyperthyroidism is made. Some people do develop thyroid eye disease a Children’s and Young People’s Working long time before or a long time after their thyroid problem becomes apparent. Party of the Chronic Illness Alliance What are the features of thyroid eye disease? (CIA) was formed to address issues of Thyroid eye disease has two distinct phases: concern to children and young people 1. The first phase is characterised by active inflammation and swelling. In this with a chronic illness. It will look at the phase the eye is often red and inflamed. The lids are swollen and the eye is relationships between them and hospitals “poppy”. Often in this phase there is quite a bit of discomfort and ache, espe- as well as the need to inform schools of cially at night. issues they face in trying to maintain as 2. As this phase resolves the muscles that move the eye begin to scar and malfunc- normal a life as possible. The working tion. In this phase the upper eyelid often “retracts” (sits up too high) and dou- party will not be a “complaints’ mecha- ble vision is common. Commonly in this phase the appearance of the eye re- nism”, rather a forum to collect informa- mains prominent. tion and to advocate on behalf of chil- Either phase can be accompanied by irritation, a feeling that there is something in dren and young people with chronic ill- the eye and visual blurring. ness. Thyroid Australia encourages those What can be done to help? with an interest in children and young There is much that can be done to help patients with thyroid eye disease. The people with thyroid conditions to share ocular irritation is helped by simple lubricants (tears plus or liquifilm tears). The with us, or with the CIA, ideas and is- swelling and ache may be helped by sleeping with the head of the bed elevated by one sues so that the Working Party can better or two bricks and by using cold compresses (available from the chemist). reflect theseneeds. During the acute inflammatory phase some patients benefit from oral steroids Contact Dr Christine Walker, CIA (prednisolone) to reduce the swelling and help the pain (and visual loss). Oral ster- (03) 9614 0500 or Megan Stevens, Thy- oids must be used with caution as they have many side effects including worsening roid Australia (03) 9561 2483. the mood disturbances that thyroid patients often develop. Some patients in this phase will require radiotherapy for the swelling. Feature During the scarring phase of thyroid eye disease many people require surgery for Our feature is hyperthyroidism, their thyroid eye disease. Surgery can be used to lower the upper eyelid if it is abnor- Graves’ disease, and thyroid eye disease. mally raised. Surgery can be used to reduce the “poppyness” (proptosis) of the eyes. Our thanks to Prof Peter Colman for his If double vision is a problem then this can be fixed by surgery to move the eye mus- thoughts on the treatment of hyperthy- cles. All of this surgery is best delayed until the eye disease is as stable as possible. roidism in Australia - the approach in With any surgery it is important to weigh the potential benefits against the potential Australia seems to be different from that risks. in other countries. Our thanks also to Dr Obviously patients with hyperthyroidism will require treatment for their increased Anthony Hall for his article on thyroid thyroid hormone levels but disappointingly this correction of their hyperthyroidism eye disease, and how best to treat it. We often doesn’t help their eye disease a whole lot. also have the first contribution by one of our members, in our Over to You series. What happens in the end? A member with Graves’ disease talks Unfortunately for many people who develop it, thyroid eye disease is a long term about her diagnosis of and the difficul- problem. The acute inflammation and swelling nearly always resolve within a few ties she had with thyroid eye disease. And months but many patients are left with permanent abnormalities. About 1/3 of people did you know cats could suffer from with thyroid eye disease will have ongoing dryness, sensitivity and irritation. About hyperthyroidism as well? half of patients believe that their eyes continue to look abnormal. The good news is that with current treatments long term double vision and visual loss are very uncom- By Megan Stevens mon. If you have any questions you should speak to your endocrinologist or ophthal- mologist. Dr Anthony J H Hall, MD, FRACO, is Director, Ophthalmology Unit, Royal Melbourne Hospital Thyroid Australia Thyroid Flyer Volume 1 Number 2 April 2000 3
  • Over To You From time to time we would like to publish letters and thyroid stories from our members. So if you would like to write to us or send us the story of how, when, where and why your thyroid condition was diagnosed, and how the condition and treatment has affected you, please do so. If you are able to include any lab test results (such as TSH, T4 and T3) at the time of diagnosis and during your treatment, all the better. Letters would normally be published with the author’s name acknowledged, whereas stories would normally published anonymously, unless you specifically request to have your authorship acknowledged. We would also like to establish a section on our web site which includes these stories, so please indicate your preference as to whether or not you would like your story to be put on our web site. Please send any letters or stories to Over To You, Thyroid Australia, PO Box 2575, Fitzroy Delivery Centre VIC 3065. The first of our member contributions comes from a member with Graves’ - so it’s Over to You ... Double Trouble Trouble It all began one night when I I was the ‘Titanic’ and he (my won- twenty minutes. Then they return, couldn’t sleep. I was very restless, derful friend) was just a little tugboat, move the machine to another posi- tossing and turning. When that hap- way down below sleeping on only one tion and you lie still again. This goes pened I usually got up and go and pillow. Even now I still sleep with two on for about six or seven times. The watch TV until I get sleepy again and pillows. machine takes ‘pictures’ of your thy- go back to bed. This particular night Basically I did everything I could roid gland. Once they had finished I went into the bathroom and turned to elevate my head while sleeping. The doing this they asked me some ques- on the light, looked in the mirror, and, reason for this is that if you are lying tions. I was not given the opportu- looking back at me was my image, completely flat in the bed, the five or nity to ask them anything, as they except, instead of two eyes looking six muscles behind your eyes are more just wandered off and left me. I was at me, there were four! I then decided likely to become filled with fluid. It is so annoyed at the way in which they to watch a bit of TV. But to no avail. this build-up of fluid which causes the had treated me, that I wrote to the Everything on the screen was double eyes to protrude and to alter the way Head of the Department. He wrote too! Feeling somewhat disconcerted, we see, ie. the double vision. back to me apologising for their lack I went back to bed. At this time I also had X-rays taken of consideration. He said he would The next day I rang my optom- of my eyes, so that the eye specialist speak to those involved and get them etrist and she referred me to an eye could see the muscles behind the eyes to improve their ‘communication specialist. I saw him fairly quickly and observe exactly how swollen they and people’ skills. I couldn’t help and he thought that I either had really were with fluid. wondering how people with little or Myasthenia Gravis or Graves’ dis- My local GP had put me on some no English would feel, as I came ease. I had heard of Myasthenia tablets to help with my trembling away from the place feeling very Gravis as a distant relative of my hands and perspiration. When you low. I had to stay away from preg- grandmother’s had it. It is a terrible have Graves’ disease, your whole body nant women and babies as I was ra- disease of which there is no cure. It is working much too fast. Your heart dioactive. However, after a few days affects all the muscles in the body. I beats faster, food passes through your the radioactivity would have left my hoped that I didn’t have that! system faster, you go to the toilet more body and it was OK to be near peo- He examined my eyes very care- frequently, you seem to be more hun- ple. fully and even measured the distance gry, but you don’t gain any weight, in On seeing the endocrinologist, he with which the eyes protruded out fact, you often lose weight and you can gave me a thorough examination, from the face. He suggested I use eye perspire more quickly. However, eve- weighing me, checking my reflexes, masks (which can be bought from the rybody doesn’t always have all the listening to my heart etc. He ex- chemist) to help reduce the puffiness same symptoms. plained the type of tablets he was of my eyes and well as propping up I was then referred to an prescribing and told me what to my bed at the head, and making sure endocrinologist. He sent me off for watch out for in the way of side af- I wore sunglasses outdoors to protect blood tests which confirmed that I had fects. He was very caring and said if my eyes from the light. Graves’ disease. I also had a test in I had any problems I could even ring We did try to prop up the bed, once which they inject radioactive iodine him at home. He stressed the impor- with bricks (very dirty and messy on into your body to take a closer look at tance of taking the tablets regularly, the carpet) and then with old tel- your thyroid gland. My experience at which I did. ephone books, (not a good idea, as this big public hospital with this team Thinking back as to how I felt they tended to slip and slide about). of technicians was not a very good one. about this disease I realise that I was In the end I was propped up with four Once you swallow this medication, quite depressed at the time. With any pillows. We used to joke about it - that you have to lie perfectly still for about change to your health you eventu- 4 Thyroid Flyer Volume 1 Number 2 April 2000 Thyroid Australia
  • ally have to come to terms with it, was taking steroids. I had resisted this whether you like it or not. I was very course of action because of the many lucky in that where I worked there nasty side affects. However, as my was a counselling facility and I was eye specialist pointed out, there was friendly with one of the women there no other drug he could offer me. The A Plea to Endocrinologists who kindly photocopied information old “between a rock and a hard place” on the various tablets I was taking and situation. Throughout the World listened and talked to me whenever I Initially I was put on a very high Can you help us ensure that health needed her. dose and then gradually it was low- professionals in your area: One of the problems with this dis- ered over about two months. One of • are fully aware of the whole spectrum ease is that the symptoms can be so the worst side affects for me on the of symptoms of thyroid disease subtle that when they occur, you don’t steroids was thrush. • realize the cost effectiveness of using even notice them at first. Things like Prior to starting the course of ster- a TSH test for initial diagnosis scant periods I just put that down to oids, I took the precaution of having • understand how to interpret thyroid the fact that I was getting near the a bone density test which showed that tests correctly menopause stage of life. I had some bone loss in my left hip. I • choose the correct method of treat- I would walk to the bus stop, about haven’t had it checked again since ment ten minutes walk, and would be drip- taking the steroids so don’t know if I • are updated on latest research finds. ping in perspiration, and maybe think have had further bone density loss. Please send us the complete mailing that I was just very unfit (which I am The steroids did the trick, in spite address, e-mail address and fax of your anyway). of their side affects. Cortisone does National Medical Society so we can add A slight tremor in my legs one day, tend to make you feel pretty fantas- this to our mailing list. E-mail to TFI and I remember thinking, I wonder tic. I guess there have to be some posi- Office tfi@kos.net what that is, but then, quickly forgot tives. More importantly, it worked in about it. reducing the swelling of the eye mus- Why not present a symposium on all At least with the double vision I cles. Gradually the dosage of the ster- aspects of thyroid disease for physicians acted quickly, under the impression oids was reduced until I stopped tak- in your area or publish information in that there was something wrong with ing them altogether. your Medical Society’s magazine/news- only my eyes. Never dreaming that it With regard to the tablets for the letter? was my thyroid gland that was caus- thyroid, over many months, and fre- Originally published on the TFI web ing all the problems. quent visits to the endocrinologist, site at http://www.thyroid-fed.org/intro/ Unfortunately with Graves’ dis- (always preceded by a blood test), I endo.html. Republished with permission. ease, the eye problem tends to run in- gradually reduced my intake to 1/2 a dependently from that of the thyroid. tablet every second day. It occurred UPCOMING So, even though my endocrinologist to me that if this was all that was gradually got my thyroid under con- needed to keep my thyroid ‘on an MEETINGS trol, my eyes were getting steadily even keel’, things must be improving. We now have enough members to run worse. It’s been eleven months since I monthly support group meetings in Mel- It began from the minute I woke stopped taking any medication for the bourne. We have arranged the following up and looked around the bedroom. thyroid or for the eyes. I no longer meetings: Yes, everything was double. This see the eye specialist, but see my would last initially for about ten min- endocrinologist every six months. Royal Women’s Hospital, Grattan St, utes. Then fifteen, then half an hour. All in all I think I have been very Carlton (Melway 2B F7) Usually, by the time I was on the bus fortunate in that I no longer have dou- 27 May going to work it would have stopped. ble vision, my eyes do not protrude, 29 July Then one morning at a staff meet- my thyroid gland (touch wood), is 26 August ing it started again. This created prob- behaving itself, and thanks to the care The meetings will be held in the lems for me at work as I use a com- and attention of very good specialists Conference Room on the First Floor puter every day and everything was and my GP, understanding friends and St Matthews Anglican Church, Lum double, unless I either covered or work colleagues (who know about my Road, (c/- Earlwood Dr), Wheelers closed one eye. I even bought an eye condition) and most importantly, the Hill (Melway 71 F10) patch (black of course, like a pirate’s) love and understanding shown by my 29 April but it was too uncomfortable to wear, friend without whom I could not 24 June and besides, it drew attention to my have managed. Thank you sweet- All support group meetings will begin eyes, which was the last thing I heart. at 2.00 pm and will finish at 5.00 pm wanted. By the end of the day, when I was Next issue of the Thyroid Flyer Please diarise these dates. For more in- tired from work, relaxing reading a formation call Megan (03) 9561 2483 or The next issue of the Thyroid Flyer book or watching TV again meant Christopher (03) 9417 1720. will be published in July 2000. Articles winking or holding one hand over my or letters for publication should be sent We are also trying to organise support eye. It became obvious that there was to The Editor by 15 June 2000. meetings in country Victoria. We will only one avenue left to try, and that give you details as meetings are arranged. Thyroid Australia Thyroid Flyer Volume 1 Number 2 April 2000 5
  • HYPERTHYROIDISM By Thyroid Foundation of America The term hyperthyroidism refers to measuring the amount of thyroid hormone several weeks (during which drug treat- any condition in which there is too much in your blood. If the tests seem border- ment may be used to control hyperthy- thyroid hormone in the body. This most line and your doctor wants to know with roid symptoms), radioactive iodine dam- commonly results from a generalized certainty whether your thyroid is ages the cells which have taken it up. The overactivity of the entire thyroid gland, overactive, another sensitive blood test result is that the thyroid shrinks in size, a condition also known as diffuse toxic known as the serum TSH (thyroid-stimu- thyroid hormone production falls, and goiter or Graves’ disease. Alternatively, lating hormone) can be done. blood levels return to normal. one or more nodules or lumps in the thy- If these tests do indicate hyperthy- Though doctors make every effort to roid may become overactive, a condition roidism, the doctor may choose to obtain calculate the optimal amount of radioac- known as toxic nodular or multinodular a picture of your thyroid (thyroid scan) tive iodine needed to control the disor- goiter. Finally, a person may become to find out if your entire thyroid gland is der, not everyone will be normal after this hyperthyroid if he or she has a condition overactive or whether you have a toxic treatment. Occasionally, a patient will called thyroiditis, or if one takes too much nodular goiter or thyroiditis (thyroid in- remain hyperthyroid, though usually less thyroid hormone in tablet form. flammation). sick than before. For them, a second The symptoms of hyperthyroidism radioiodine treatment can be given if What is the Best Treatment for include nervousness, irritability, in- needed. Much more commonly, hypothy- creased perspiration, thinning of your Hyperthyroidism? roidism (an underactive thyroid) occurs skin, fine brittle hair, and muscular weak- There is no one treatment that is best after a few months. Indeed, most patients ness especially involving the upper arms for all patients with hyperthyroidism. treated with radioactive iodine will be- and thighs. Your hands may shake and Many factors will influence your doctor’s come hypothyroid after a period of sev- your heart may race. Your bowel move- choice of treatment, including your age, eral months to many years. Fortunately, ments may increase in frequency, though the type of hyperthyroidism, the availabil- hypothyroidism is an easy condition to diarrhea is uncommon. Usually you will ity of a good thyroid surgeon, allergy to treat with thyroid hormone supplemen- lose weight despite a good appetite and, medication, the severity of the hyperthy- tation taken once-a-day to make up for if you are a woman, menstrual flow may roidism, and other medical conditions the hormone which the thyroid gland is lighten and menstrual periods may occur which may be affecting your health. no longer able to produce. This medica- less frequently. Drugs: tion must be taken for the rest of the pa- In diffuse toxic goiter (Graves’ dis- Drugs known as antithyroid agents, tient’s life. ease) the eyes may appear enlarged due methimazole (Tapazole®) or propylthiou- to elevation of the upper lids. Less com- Surgery: racil (PTU), may be prescribed if your For an occasional patient with hyper- monly, a protrusion of one or both eyes doctor chooses to treat the hyperthy- known as exophthalmos may occur. thyroidism, the physician will recom- roidism by lowering the amount of thy- mend removing part of the thyroid gland What Causes Hyperthyroidism? roid hormone in your blood. These drugs in an operation. The operation is fairly Diffuse toxic goiter, found in 70-80% make it more difficult for iodine to be used straightforward if a single nodule or lump of patients with hyperthyroidism, is by your thyroid gland. Since your thyroid of thyroid tissue is overactive. In such caused by antibodies in the blood which uses iodine to make thyroid hormone, the patients, the surgeon removes the part of stimulate the thyroid to grow and secrete net effect is a decrease in thyroid hormone the thyroid containing the overactive nod- excessive amounts of thyroid hormone. production. ule and the rest of the thyroid usually re- This type of hyperthyroidism tends to run Radioactive Iodine: turns to normal function. On the other in families, but we really don’t know very Another way to treat hyperthyroidism hand, if many nodules are overactive, or much about why this disease occurs in is to damage the thyroid cells which make if the problem is generalized overactivity specific individuals. We also do not un- thyroid hormone. Since these cells need of the entire thyroid gland, the surgeon derstand why thyroid nodules sometimes iodine to make thyroid hormone, they must remove most of the thyroid in or- become overactive. Somehow one or readily take up any form of iodine from der to restore good health. If this is done, more nodules gradually increase their your blood stream. In the late 1930’s phy- hypothyroidism will usually occur and activity, so that their total output of thy- sicians learned that the thyroid would take the patient must take a thyroid hormone roid hormone is greater than normal. up radioactive iodine in the same manner supplement for the rest of his or her life. When thyroiditis occurs it may have been as normal, nonradioactive iodine, an ob- However, by removing most of the thy- caused by an infective process, but as yet servation that led to radioactive iodine roid, the risk of the patient remaining no specific causative virus or bacteria has therapy. In this form of treatment, your hyperthyroid is greatly diminished. The been identified. doctor administers a capsule or a drink of considerations regarding thyroid surgery water containing radioactive iodine which are important and complex. Therefore, How is Hyperthyroidism Diag- is tasteless and odorless. Once swallowed, when a physician recommends this form nosed? of therapy, careful discussion should take the radioiodine gets into your blood If your doctor suspects hyperthy- place regarding the alternatives for treat- stream and quickly is taken up by the roidism, he or she will first try to find ment, the nature and extent of the planned overactive thyroid cells. Over a period of out whether that diagnosis is correct by Continued Page 8 6 Thyroid Flyer Volume 1 Number 2 April 2000 Thyroid Australia
  • Telephone Contacts A group of members has agreed to Hypothyroidism, Iatrogenic (caused by able arrangements will be made to enable support others with thyroid conditions in treatment) those members from outside of Mel- their times of need. These Telephone Colleen (03) 9561 2653 bourne to attend a workshop, and there- Contacts follow our guidelines in an ef- Thyroid Conditions in Later Life fore to act as Contacts.) fort to provide reliable information to Colleen (03) 9561 2653 We would like more volunteers will- callers. Contacts are not generally medi- Thyroid Hormone Replacement ing to share their experiences of their thy- cally trained nor are they trained coun- Therapy roid conditions and treatments, such as sellors, but they will be able to provide a Megan (03) 9561 2483 hypothyroidism, hyperthyroidism, personal viewpoint, through their own Kay (03) 9560 4688 Hashimoto’s thyroiditis, Graves’ disease, experience of the conditions or treatments T4/T3 Conversion thyroid hormone replacement therapy, for which they are listed. Robyn 9754 6281 thyroid hormone suppression treatment, Please be considerate about when you Thyroid Eye Disease anti-thyroid medication, thyroid cancer, ring - the Contacts are all volunteers who Karen (03) 9380 8505 thyroidectomies (full or partial), surgery also have lives of their own to lead. for thyroid eye disease (orbital decom- We would like to expand the list of Anti-Thyroid Medication pression, eyelid surgery), radioactive io- contacts in order to provide a better serv- Christopher (03) 9417 1720 dine treatment (RAI), congenital hy- ice. Contacts must have, or want to have, Karen (03) 9380 8505 pothyroidism, juvenile thyroid conditions a sound knowledge of the conditions and Graves’ Disease (hypo- and hyperthyroidism), thyroid treatments for which they are volunteer- Christopher (03) 9417 1720 nodules (single and multi-nodular), thy- ing. We will provide all volunteers with Karen (03) 9380 8505 roid cysts, subacute thyroiditis, postpar- a pack of reliable information as well as Hashimoto’s Thyroiditis tum thyroiditis, pregnancy and fertility, access to all the articles on the Publica- Megan (03) 9561 2483 hyperparathyroidism, hypoparathy- tions List - this way you can help your- Kay (03) 9560 4688 roidism, etc. self while helping others. Robyn (03) 9754 6281 To this end Contacts are asked to at- If any member would like to volun- Hyperthyroidism tend a short workshop to go through the teer as a Telephone Contact, could they Christopher (03) 9417 1720 requirements for this position. This is to please contact Megan Stevens on (03) Karen (03) 9380 8505 ensure that all Contacts work off the same 9561 2483 or Christopher McDermott Hypothyroidism knowledge base, and to allow them to on (03) 9417 1720; or e-mail Thyroid Megan(03) 9561 2483 gain some insights from others who have Australia at support@thyroid.org.au Kay (03) 9560 4688 been performing this task already. (Suit- Robyn (03) 9754 6281 Know Your TSH By Larry Wood Today, as part of the advances in mod- will be high as your pituitary gland tries cancer cells, your TSH level should be ern medicine, there are many common to stimulate the thyroid gland to produce low. screening tests which are indicators of more hormone. It is a bit like turning the Whatever the situation is for you, be good health or of potential health prob- thermostat up or down if the house is too sure you discuss your TSH results with lems. These include tests for cholesterol cold or too hot. your physician at the time of your regu- as a measure of risk for heart disease, a The TSH test is the single most im- lar checkups and, above all, know your blood sugar test to detect diabetes, and a portant test to screen for hyper or hy- own TSH number and where it fits within PSA level test which indicates in men the pothyroidism, and the only reliable way the normal range. Keep a record of the risk for prostate cancer. to tell if your dose of thyroid hormone is results of each TSH test, note any major Fortunately, there is also a thyroid test right for you. If you are hypothyroid and changes and discuss them with your doc- which tells you whether your thyroid hor- taking thyroid hormone, your TSH should tor. Being well informed about your own mone levels are right for you. It is called be in the normal range. In many labora- condition is surely one of the best ways a TSH test (thyroid stimulating hormone) tories, this is 0.5 - 5.0 microunits/ml but to help yourself. and consists of taking a small sample of you should check the laboratory’s normal blood which is then sent to a laboratory range as some assays vary in their sensi- Dr Lawrence C Wood, MD, FACP for analysis. All thyroid patients should tivity and range of normal values. The (USA), is President of the Thyroid Fed- know their test results and what these normal range may also vary somewhat eration International. numbers may indicate. from country to country. If your TSH re- For example, if you have too much sults are outside the normal range, fur- This article was published in thyroid hormone in your blood (hyper- ther tests of T-3 and T-4 hormones may ThyroWorld, Spring 1999, Volume 2, thyroidism), your pituitary gland senses be in order. Number 1. ThyroWorld is the official this and decreases the production of TSH. If you have thyroid cancer, and your newsletter of the Thyroid Federation In- If, however, your thyroid hormone level physician is giving you high doses of thy- ternational. is low (hypothyroidism), your TSH level roid hormone to suppress the activity of Reprinted with permission. Thyroid Australia Thyroid Flyer Volume 1 Number 2 April 2000 7
  • Hyperthyroidism from Recommended Web Sites Page 6 Chronic Illness Alliance: http:// fairly rare form of thyroid cancer known as operation, and the choice of surgeon. www.chronicillness.org.au [Based in Medullary Thyroid Carcinoma. It was created If a patient is unconvinced or unclear Melbourne. Represents groups through- and is maintained by an MTC sufferer.] about the need for surgery (or any out Victoria - including Thyroid Aus- National Graves’ Disease Foundation: other thyroid treatment plan), a sec- http://www.ngdf.org ond opinion is a good idea. tralia.] NSW Health, Multicultural Health Com- Quackwatch: http://familyinternet.com/ quackwatch/index.html [Guide to health munication Service Other Treatment: http://www.health.nsw.gov.au-public-affairs/ A class of drugs known as the beta fraud, quackery, and intelligent decisions, mhcs/ [Includes material on a number of adrenergic blocking agents block the operated by Stephen Barrett, M.D.] health concerns, including one on How thy- Thyroid Homepage: http:// action of thyroid hormone on your roid problems affect your health. These pub- www.thyrolink.com [From Merck KgaA, body, and usually make you feel bet- lications are in a number of languages other Darmstadt, Germany.] ter within hours, even though they do than English - the one on thyroid problems Patient Information being in Arabic, Chinese, Croatian, English, not change the high levels of thyroid American Autoimmune Related Diseases Greek, Italian, Khmer/Cambodian, Korean, hormone in your blood. Propranolol Association: http://www.aarda.org/ Laotian, Macedonian, Portuguese, Russian, (Inderal®) was the first of these drugs index.html Spanish, Thai, Turkish, and Vietnamese.] to be developed. Related but longer- American Foundation of Thyroid Patients: Papillary Thyroid Cancer: An Inquiring Pa- acting beta-blocking drugs such as http://www.thyroidfoundation.org/ tient’s Guide: http://www.netcomuk.co.uk/ atenolol (Tenormin®), metoprolol Columbia-Presbyterian Medical Center: ~lawrence/PTC/links.html (Lopressor®) and nadolol Thyroid Center: http://cpmcnet.columbia.edu/ ThyCa: The Thyroid Cancer Survivor’s As- sociation: http://www.thyca.org (Corgard®), and Inderal-LA® are dept/thyroid/ Thyroid Federation International: now preferred by some physicians Diabetes & Hormone Center of the Pacific: Thyroid Disorders: http://www.thyroid-fed.org/home.html because of their more convenient http://www.endocrinologist.com/thyroid.htm Thyroid Foundation of America: http:// once- or twice-a-day dosage. Except EndocrineWeb.com: http:// www.tsh.org and http://www.tfaweb.org/pub/ for hyperthyroidism caused by thy- www.endocrineweb.com [The largest web site tfa roiditis, these drugs are not the only for thyroid, parathyroid, adrenal, and pancreas Thyroid Foundation of Canada: http:// form of therapy, but are used in com- disorders, including diabetes and osteoporo- home.ican.net/~thyroid/Canada.html bination with other treatments that are sis. The information is intended for the edu- The Thyroid Society for Education and Re- specifically directed towards the thy- cation of patients and their families. Pages are search: http://www.the-thyroid-society.org The University of Texas MD Anderson Can- roid gland. added at least twice a week.] Florida Thyroid Endocrine Clinic: http:// cer Center: Educational Materials: homestead.com/thyroid_doctor/index- http://endocrine.mdacc.tmc.edu/ This information is provided by the ns4.html [Webpage of H Jack Baskin MD. educational.html Thyroid Foundation of America on Also includes a link to Dr Baskin’s book How their Web site at address http:// Professional Information www.clark.net/pub/tfa/hyperbro.htm Your Thyroid Works American Association of Clinical http://howyourthyroidworks.homestead.com/ Endocrinologists: http://www.aace.com index-ns4.html] Republished with permission. American Thyroid Association: Gland Central: Your Thyroid: http:// http://www.thyroid.org www.glandcentral.com/home.html The Endocrine Society: The MAGIC Foundation for Children’s Growth: http://www.magicfoundation.org/ http://www.endo-society.org Membership The Endocrine Society of Australia: [Go to their Informational Brochures to get to Thyroid Disorders.] http://www.racp.edu.au/esa/ Application Form Mary Shomon - About.Com Guide to Thy- International Council for the Control of Io- roid Disease: http://thyroid.about.com/health/ dine Deficiency Disorders: Included is a membership applica- diseases/thyroid [Please note that this site also http://www.tulane.edu/~icec/icciddhome.htm tion form, so if you have not yet joined, contains links to and information about alter- Thyroid Disease Manager: http:// www.thyroidmanager.org [Contains the re- you can do so, or if you are a member, native and complementary diagnoses and you can give it to a friend who might like treatments which are not considered main- vised version of the textbook “The Thyroid and its Diseases”, and supplementary infor- to join as well. stream by conventional medical practitioners. This site and its editor/webmaster, however, mation. Directed at helping medical practi- tioners care for their patients with thyroid Disclaimer are not funded, supported by, or subsidised in any way by companies who manufacture thy- problems. Developed by Leslie J. De Groot, All materials provided by Thyroid roid hormone, thyroid treatment, or thyroid M.D., Georg Hennemann, M.D. and a group of thyroid experts, including Australian Dr. Australia are for information purposes diagnostic drugs or testing.) only and do not constitute medical The MTC site: http://perso.wanadoo.es/ Basil Hetzel.] advice. briant/index.html [This site is devoted to the Thyroid Australia Postal Address: PO Box 2575, Fitzroy Delivery Centre VIC 3065 Office: 43 Donald Rd, Wheelers Hill VIC 3150 Phone: (03) 9561 2483 Fax: (03) 9561 4798 E-Mail: support@thyroid.org.au Web: www.thyroid.org.au 8 Thyroid Flyer Volume 1 Number 2 April 2000 Thyroid Australia