Thyroid Tune-up: Update
I am re-posting a classic Wheat Belly Blog post from a few years ago. Despite all our discussions about thyroid issues, there continues to be an enormous gap: undiagnosed hypothyroidism, gross mismanagement sufficient to impair weight loss and increase cardiovascular risk, and ignorance among healthcare providers. This Thyroid Tune-up is therefore an updated version of the previous post.
Imagine that all the cars in your neighborhood run poorly because nobody bothers to tune-up their autos. I show you how to tune your car and, lo and behold, 80% of the cars now run great. But 20% of cars still run poorly because their tra...
Source: Wheat Belly Blog - April 28, 2015 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle gluten grains hypothyroidism iodine t3 t4 TSH Weight Loss Source Type: blogs
Amiodarone and thyroid dysfunction
Brief Review
Amiodarone is one of the most widely used anti arrhythmic drug. It is well known that amiodarone can induce both hypothyroidism and hyperthyroidism due to the iodine content of the drug. 200 milligrams of amiodarone daily would deliver twenty to forty times the usual daily iodine intake. Amiodarone reduces 5-deiodinase activity and thereby the monodeiodination of T4 to T3. There is decreased generation of T3 and reduced clearance of rT3 (reverse T3), which accumulates. Destructive thyroiditis is due to the direct toxic effect of amiodarone and its metabolite on the thyroid follicular cells.1
It has been menti...
Source: Cardiophile MD - December 21, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Customizing Communication, or Which One I Sent
It’s been a fascinating week or so listening to everyone weigh in on which response they thought I sent to my patient (also here.) The general consensus, unsurprisingly, was that the first was far too cheeky — not to mention insulting — to effectively convey the necessary information. The second, of course, was the one I send every day, day in and day out. Just this once, circumstances conspired to allow me to send the first.
Let me explain.
I’d like to begin by quoting myself:
I find it amusing to intentionally adopt a far more curmudgeonly attitude here than I would ever dream of displaying in...
Source: Musings of a Dinosaur - December 5, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Which One Did I Send?
Middle-aged lady, twenty pounds overweight.
Doing everything I can, doctor. Everything imaginable. Diet: I eat practically nothing. Exercise: all the time! Weight Watchers doesn’t work. Jenny Craig, South Beach, the Zone; I’ve tried it all. Nothing works. Have to lose weight. Have to lose weight.
Yadda yadda yadda.
Oh look: a few years back I diagnosed you as hypothyroid and gave you some Synthroid. Are you taking it?
Nah; I stopped that. I just didn’t want to take it.
Hm. Send some blood work. Low and behold: TSH is 7. That’s high, and it means her thyroid is underactive, which is probably a big pa...
Source: Musings of a Dinosaur - November 23, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
MKSAP: 42-year-old woman with crampy abdominal pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 42-year-old woman is evaluated for an 8-month history of crampy abdominal pain and three loose bowel movements per day. The pain is relieved by a bowel movement. There are no nocturnal bowel movements, and there is no blood or dark tarry material in the stool. She has not had fever, night sweats, or weight loss. She has a history of Hashimoto disease and is treated with levothyroxine.
On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 128/84 mm Hg, pulse rate is 64/min, and respirat...
Source: Kevin, M.D. - Medical Weblog - September 6, 2014 Category: Journals (General) Authors: mksap Tags: Conditions GI Source Type: blogs
How to obtain levoxyl: Success Stories
I wanted to share a success story from a commenter on my blog. Bonnie has posted a lot throughout the Pfizer levoxyl shortage. I am happy for her that she was able to obtain her levoxyl thyroid medication and wanted to share the comment she left in case it can be of help to you too:
“I was able to get my Levoxyl about a week ago. I called the customer service number at Levoxyl.com after seeing that all strengths were available on the FDA drug shortage website. I wanted to verify the March 3rd date and I was told Levoxyl was finished being produced and was shipped out to the wholesalers. Your...
Source: Everything Changes - February 13, 2014 Category: Cancer Authors: Kairol Rosenthal Tags: Uncategorized cvs duane reade rite aid walgreens Source Type: blogs
Levoxyl Shortage – February 2014 Update
UPDATE: As of 2/7/2014, a commenter on my blog states they were able to obtain 100 mcg pills of levoxyl at their Rite Aid pharmacy in Pittsburgh. They placed the order in the morning and pharmacist had them ready at the end of the day. Great news. Scroll down to see the full comment and please leave your comments below once you have obtained levoxyl in your area too.
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Rumors are flying that levoxyl is now back on the shelves and available for patient purchase. I want to clarify this speculation and provide the most accurate and up to date information that I am able to find. Here is the information ...
Source: Everything Changes - February 3, 2014 Category: Cancer Authors: Kairol Rosenthal Tags: Uncategorized Source Type: blogs
Damn, more meds!
And an expensive one at that. My pain doctor put me back on Lyrica. We tried it about four years ago for the nerve pain issues I was having with my back. We decided it didn't really work for me after about 9 months so I went off it. But now that I have been diagnosed with fibromyalgia, my doctor is suggesting I try Lyrica again.I don't have a problem with it. My fibro pain has been pretty bad. Just sitting still, knitting, watching TV, driving, or whatever, all of a sudden I will get a bone deep pain in my arm that shoots up to about a 9 or so. Then it goes away. So its no like you can treat it specifically. Sometimes I ic...
Source: Caroline's Breast Cancer Blog - November 16, 2013 Category: Cancer Tags: doctor appointments prescriptions Source Type: blogs
How to learn about prescription drug ingredients?
Due to a recent recall of the thyroid medication levoxyl, my blog has been a buzz with detailed comments about pharmaceuticals. A few of these comments centered around allergies to inactive ingredients. I am learning what a hardship this is for many cancer patients and others suffering from chronic illnesses, including those who need gluten free products because of Celiac disease. I began to wonder where patients can find reliable information about the content of specific drugs.
I love sharing new resources I’ve found and this is a good one: Daily Med. It contains a database of FDA approved inserts found in pr...
Source: Everything Changes - August 12, 2013 Category: Cancer Authors: Kairol Rosenthal Tags: Uncategorized young adult cancer thyroid cancer medical research advocacy drug reactions drug side effects Source Type: blogs
Positive Strategies for Coping with Levoxyl Shortage
From young adult thyroid cancer patients, to those suffering from Graves’ Disease, Hasimoto’s, and other hyperthyroid and hypothyroid conditions, I have been receiving many emails from distressed patients coping with the recent shortage of levoxyl. Pfizer says it will resume production of levoxyl in 2014, and until then many of us are coping as we try to adjust to new medications like synthroid or generic levothyroxine.
As with any medical issue it is often the challenging and horrific stories that we hear about the most. So I wanted to take the time to present some positive experiences I have encounte...
Source: Everything Changes - July 1, 2013 Category: Cancer Authors: Kairol Rosenthal Tags: Uncategorized Source Type: blogs
What can patients do about the levoxyl recall?
In response to Pfizer’s voluntary recall of levoxyl, I have received many comments from young adult cancer patients and others living with thyroid health issues. Many have asked what patients can do to urge the company and FDA to resume production of levoxyl prior to the target date of 2014. I believe patient pressure on Pfizer and the FDA will have no impact; unfortunately we must instead experiment with other thyroid replacement hormones, like synthroid, and manage the burden of their potential side effects. Here’s why:
King Pharmaceuticals manufactured levoxyl in their Bristol, TN plant until 20...
Source: Everything Changes - June 18, 2013 Category: Cancer Authors: Kairol Rosenthal Tags: Uncategorized Source Type: blogs
MKSAP: 27-year-old pregnant woman with hypothyroidism
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 27-year-old woman is evaluated during the fourth week of an uneventful pregnancy. She has a 3-year history of primary hypothyroidism due to Hashimoto thyroiditis that is treated with levothyroxine, 125 µg/d. She also takes prenatal vitamins and iron sulfate.
On physical examination, temperature is 37.1 °C (98.8 °F), blood pressure is 128/80 mm Hg, pulse rate is 95/min, and respiration rate is 18/min and regular; BMI is 25. She has a mild fine hand tremor. Lung, cardiac, and skin examination findings are norm...
Source: Kevin, M.D. - Medical Weblog - May 11, 2013 Category: Family Physicians Tags: Conditions Endocrinology OB/GYN Source Type: blogs
Levoxyl Shortage for Thyroid Patients
I recently tried to refill my prescription for Levoxyl and learned I cannot due to a recall by the manufacturer Pfizer. I called Pfizer this morning and spoke to a robotic, though pleasant, customer service representative in India. She provided little useful information. Between my own research on the FDA and American Thyroid Association websites I learned the following:
* Pfizer has suspended production of Levoxyl, which is manufactured at a plant in Tennessee. Chemical contamination is the reason for suspended production. Emission of a strong odor was reported by pharmacists when opening 100 and 1000 ta...
Source: Everything Changes - May 9, 2013 Category: Cancer Authors: Kairol Rosenthal Tags: Uncategorized thyroid cancer levoxyl papillary carcinoma synthroid Source Type: blogs
