Diabetes Talking

Question:

Doctors really need to fine tune levo dosing for optimal taking into consideration both lab results ‘and’ their patients symptoms.

That’s what my medical books say. In fact they say symptoms are often more reliable than lab results. Since lab results can lag behind improvement by quite a bit, and can be affected by many factors besides the status of the thyroid. :: One thing I`ve noted reading the thyroid newsgroup is that many people :: with supposed "normal" thyroid levels still feel lousy. :: ::Maybe their thyroid isn’t their problem. I`m sure for many people there are other issues. However, from all the reading I`v done, lurking at the thyroid group…. and talking to people in real life they have never gotten back to the person they were pre-thyroid disorder even though they are told their thyroid levels are in the normal range. That is true for myself as well.

Curr Opin Pharmacol. 2002 Dec;2(6):717-22. Dissatisfaction with thyroxine therapy – could the patients be right? **Walsh JP**. Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, WA In some patients with hypothyroidism, symptoms of ill health persist despite thyroxine treatment. It is unclear whether this arises from comorbidity or because standard thyroxine replacement is in some way inadequate for some individuals. Some patients feel better if they take a slightly excessive dose of thyroxine, but this carries a potential risk of adverse cardiac and skeletal effects. There are conflicting data on whether combined thyroxine/triiodothyronine treatment is preferable to thyroxine alone in dissatisfied patients. PMID: 12482736 [PubMed - indexed for MEDLINE] J Clin Endocrinol Metab. 2003 Oct;88(10):4543-50. Combined thyroxine/liothyronine treatment does *not* improve well-being, quality of life, or cognitive function compared to thyroxine alone: a randomized controlled trial in patients with primary hypothyroidism. **Walsh JP**, Shiels L, Lim EM, Bhagat CI, Ward LC, Stuckey BG, Dhaliwal SS, Chew GT, Bhagat MC, Cussons AJ. Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, T(4) is standard treatment for hypothyroidism. A recent study reported that combined T(4)/liothyronine (T(3)) treatment improved well-being and cognitive function compared with T(4) alone. We conducted a double-blind, randomized, controlled trial with a crossover design in 110 patients (101 completers) with primary hypothyroidism in which liothyronine 10 micro g was substituted for 50 micro g of the patients’ usual T(4) dose. No significant (P < 0.05) difference between T(4) and combined T(4)/T(3) treatment was demonstrated on cognitive function, quality of life scores, Thyroid Symptom Questionnaire scores, subjective satisfaction with treatment, or eight of 10 visual analog scales assessing symptoms. For the General Health Questionnaire-28 and visual analog scales assessing anxiety and nausea, scores were significantly (P < 0.05) worse for combined treatment than for T(4) alone. Serum TSH was lower during T(4) treatment than during combined T(4)/T(3) treatment (mean +/- SEM, 1.5 +/- 0.2 vs. 3.1 +/- 0.2 mU/liter; P < 0.001), a potentially confounding factor; however, subgroup analysis of subjects with comparable serum TSH concentrations during each treatment showed no benefit from combined treatment compared with T(4) alone. We conclude that in the doses used in this study, combined T(4)/T(3) treatment does not improve well-being, cognitive function, or quality of life compared with T(4) alone. PMID: 14557419 [PubMed - indexed for MEDLINE] — The charter is available at: http://readystump.algebra.com/~asapm

Response:

:: ::You know, my thyroid could be low, but if it is then it is well and truly ::dead now (Hashimoto’s).  My dose is now at 200 mcgs, the highest I’ve ever ::been on.  I’ll get my TSH tested this week. I think mine is taking its last breath as well. I`m also at 200 mcgs and still feel lousy. I feel discouraged being I am in so much pain everyday. My doctor mentioned last time that it may be time to see a rheumatologist.

Jackie, have you ever considered taking a mixture of T3 and T4? Chip — The charter is available at: http://readystump.algebra.com/~asapm

Response:

::Jackie, have you ever considered taking a mixture of T3 and T4? I am going to approach my doctor about this. It may also be time to seek advice from a endocrinologist. I was very sick in Jan of 2005 with some kind of flu or virus. I completely lost my voice. I have not felt well since that time. Last weekend I was in such agony with pain that it made me cry a few times.

I’m sorry to hear you felt so bad, Jackie. Some of my finger joints ache a little and get stiff when it gets cold. I think it’s osteoarthritis in me. The cold weather back East could be making your joints act up, but there has to be some underlying pathology (e.g. osteo, RA, hypo-T, whatever, etc). When I had German measles I had arthralgias in my finger joints. They also felt slightly stiff. That was 40 years ago. That is the weekend we had that wicked blizzard. I`m feeling much better the last few days, even with it being bitterly cold here. What are your thoughts on armour?

I have mixed thoughts on dessicated thyroid. Endocrinologists, for the most part, say not to use it. Although they say there may be a very small population of people who are unable to convert T4 to T3, and these may benefit from the addition of T3 to T4. Some lay people say Armour makes them feel better. I don’t know whether they feel better because of a placebo effect. I`ve done lots of research on thyroid disorders, have many books. There is so much confusion surrounding these disorders and how to treat them.

There isn’t much confusion in medical books. They say the med of choice for hypothyroidism is levothyroxin (levo-T4). One thing I`ve noted reading the thyroid newsgroup is that many people with supposed "normal" thyroid levels still feel lousy.

Maybe their thyroid isn’t their problem. Chip — The charter is available at: http://readystump.algebra.com/~asapm

Response:

– Hide quoted text — Show quoted text – :: ::You know, my thyroid could be low, but if it is then it is well and truly ::dead now (Hashimoto’s).  My dose is now at 200 mcgs, the highest I’ve ever ::been on.  I’ll get my TSH tested this week. I think mine is taking its last breath as well. I`m also at 200 mcgs and still feel lousy. I feel discouraged being I am in so much pain everyday. My doctor mentioned last time that it may be time to see a rheumatologist. I suspect she feels some of the pain is not thyroid related. Do you have joint and muscle pain when you are low? Make sure to take your synthroid an hour or two before you eat, don`t take it with any other meds. Calcium and iron can interfere with absorption, as can soy products. My doctor feels synthroid is best absorbed taken at bedtime. I tried it but felt to wound up and couldn`t sleep. Let me know what your bloodwork shows. Feel better soon! (((((Dawn))))) Jackie ~*~However, no two people see the external world in exactly the same way. To every separate person a thing is what he thinks it is–in other words, not a thing, but a think~*~   ~~ Penelope Fitzgerald

Jackie, I’m so sorry you are having so much pain.  I think it’s a good idea to see a rheumatologist in case it is something besides your thyroid.  I don’t get joint and muscle pain yet unless I exercise too strenuously.  Yet is the key word.  I already have two auto-immune disorders and another seems likely at some point.  Oh well. I take my thyroid meds right before I go to sleep, and have for years.  They don’t bother me.  I am curious to see where my TSH is at right now.  It could be high, but I think it’s probably sitting between 0 and 2, and more likely at the lower end of that range. I’ll let you know what’s up when I get my numbers back.  I have to go get tested first, of course . I hope you find a cause and fix for your pain very soon. (((((((((((((Jackie))))))))))))) Love, Dawn — The charter is available at: http://readystump.algebra.com/~asapm

Response:

- Hide quoted text — Show quoted text – Weird timing, but just two days ago, I don’t know exactly how I did it, but I was closing my mouth in such a way that made one side "pressurized".  Suddenly I felt air rush into that tube and there was literally a little bulge in the skin just below my ear.  As if it made a little balloon.  I pressed on the bulge and the air went out again into my mouth.  Being the curious little boy I am, I did it a couple more times until it hurt, then I stopped. Tony, consider a Branchial cleft cyst, sinus, or fistula. Branchial clefts (in the neck) usually disappear before an infant is born. Sometimes remnants of the cleft(s) remain in children and adults. The remnants can take 3 forms: cysts, fistulas, and sinus tracts. A cyst is a mass filled with liquid. (doesn’t sound like you) A fistula is a tract (or pathway) which has 2 openings, such as into the throat and through the skin of the neck to the outside world. A branchial sinus is a tract (pathway) with only one opening. That’s what you may have: a branchial cleft sinus that opens in the throat (pharynx) , but doesn’t connect to the skin surface. So it can fill with air and distend some soft tissues near your ear.

Unless it has a habit of becoming infected, is there any reason to do anything? BTW, any little dimples in the side of the neck under the ear? Or drainage from the side of the neck?

Ewww, no. I often have problems with the air pressure on the outside not equalizing with the inside.  I thought maybe it had something to do with that?  Just driving through some of the mountains in Virginia cause my ear/s to act ’stuffed up’ or whatever.  I don’t think the changes in elevation (and barometric pressure) are that much, but I don’t really know.  I do know that when driving up and down in elevation it didn’t bother my mother a bit but it was quite a nuisance to me.  Chewing gum and yawning didn’t help. Tono — The charter is available at: http://readystump.algebra.com/~asapm

Response:

A branchial sinus is a tract (pathway) with only one opening. That’s what you may have: a branchial cleft sinus that opens in the throat (pharynx) , but doesn’t connect to the skin surface. So it can fill with air and distend some soft tissues near your ear. Unless it has a habit of becoming infected, is there any reason to do anything?

Tony, unless you develope bothersome symptoms, I would do *nothing*, based on the below info: "Mortality/Morbidity:   The possibility of carcinoma arising in a branchial remnant is controversial; recent reports suggest branchiogenic carcinoma is possible" From *several* abstracts on Pub Med:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed "Branchiogenic carcinoma occurs only rarely." "The existence of branchiogenic carcinoma remains controversial." "Branchiogenic carcinoma is extremely rare." "The existence of primary branchiogenic carcinoma is controversial." I often have problems with the air pressure on the outside not equalizing with the inside.

That is auditory tube dysfuntion. AKA eustachian or ear tube dysfunction. I thought maybe it had something to do with that?

I can’t think of any way they’d be connected. Just driving through some of the mountains in Virginia cause my ear/s to act ’stuffed up’ or whatever.  I don’t think the changes in elevation (and barometric pressure) are that much, but I don’t really know.

The changes in elevation are enough to affect you, which is consistant with auditory tube dysfunction. I do know that when driving up and down in elevation it didn’t bother my mother a bit but it was quite a nuisance to me.  Chewing gum and yawning didn’t help.

Check out this: "Auditory Tube Dysfunction The tube that connects the middle ear to the nasopharynx-the auditory tube, or eustachian tube-provides ventilation and drainage for the middle ear cleft. It is normally closed, opening only during the act of swallowing or yawning. When auditory tube function is compromised, air trapped within the middle ear becomes absorbed and negative pressure results. The most common causes of auditory tube dysfunction are diseases associated with edema of the tubal lining, such as viral upper respiratory tract infections and *allergy*.  (note from Chip: sometimes people have congenitally narrow tubes) The patient usually reports a sense of fullness in the ear and mild to moderate impairment of hearing. When the tube is only partially blocked, swallowing or yawning may elicit a popping or crackling sound. Following a viral illness, this disorder is usually transient, lasting days to weeks. Treatment with systemic and intranasal decongestants (eg, pseudoephedrine, 60 mg orally every 4 hours; oxymetazoline, 0.05% spray every 8-12 hours) combined with autoinflation by forced exhalation against closed nostrils may hasten relief. Autoinflation should not be recommended to patients with active intranasal infection, since this maneuver may precipitate middle ear infection. Allergic patients may also benefit from desensitization or intranasal corticosteroids (eg, beclomethasone dipropionate, two sprays in each nostril twice daily for 2-6 weeks). Air travel, rapid altitudinal change, and underwater diving should be avoided." Tierney, McPhee, and Papadakis, published by Lange Medical Books/McGraw-Hill Chip — The charter is available at: http://readystump.algebra.com/~asapm

Response:

– Hide quoted text — Show quoted text – ::I have this weird problem and I was wondering if anyone has experienced this ::or knows what causes it.  When I exert myself in exercise (not aerobic – ::Pilates floor stuff), I often can hear my breathing inside my ear.  It’s ::like a rushing sound IN my ear when I breathe.  My ear feels kind of ::plugged, too.  I also get dizzy and lightheaded.  Anyone know what this is? I have no idea what this is. It sounds distressing though. Make sure to let your doctor know next time you have an appt. Hope you are feeling better now. (((((Dawn))))) ::Also, is it normal to have a low temperature, like 95?  Today I felt kind of ::off and my temp registered as 94.2 and 95.1 on three different thermometers. ::Everyone but me has had the flu with a fever–I get something with a reverse ::fever.  Trust me to do it up right ;-P. When my body temp is that low it means my thyroid is hypo again.  I know you recently increased your synthroid. How are you feeling otherwise? Make your doctor aware if the low temps continue. Jackie ~*~I answer the heroic question "Death, where is they sting?" with "It is here in my heart and mind and memories~*~   ~~ Maya Angelou

Jackie, You know, my thyroid could be low, but if it is then it is well and truly dead now (Hashimoto’s).  My dose is now at 200 mcgs, the highest I’ve ever been on.  I’ll get my TSH tested this week. Otherwise, I feel ok.  I had a touch of the flu (very mild) for about four-five days, but it’s gone now. Thanks for reminding me of that! Dawn — The charter is available at: http://readystump.algebra.com/~asapm

Response:

– Hide quoted text — Show quoted text – Hello all, I have this *weird problem* and I was wondering if anyone has experienced this or knows what causes it.  When I exert myself in exercise (not aerobic – Pilates floor stuff), *I often can hear my breathing inside my ear*. It’s like a rushing sound IN my ear *when I breathe*.  My *ear feels kind of plugged*, too.  I also get dizzy and lightheaded.  Anyone know what this is? Auditory Tube Dysfunction The tube that connects the middle ear to the nasopharynx-the auditory tube, or eustachian tube-provides ventilation and drainage for the middle ear cleft. It is normally closed, opening only during the act of swallowing or yawning. (1)  tube can be too narrow: When auditory tube function is compromised, air trapped within the middle ear becomes absorbed and negative pressure results. The most common causes of auditory tube dysfunction are diseases associated with edema of the tubal lining, such as viral upper respiratory tract infections and allergy. The patient usually reports a sense of fullness in the ear and mild to moderate impairment of hearing. When the tube is only partially blocked, swallowing or yawning may elicit a popping or crackling sound. (2) tube can be too open or wide: An overly patent auditory tube is a relatively uncommon problem that may be quite distressing. Typical complaints include *fullness in the ear* and *autophony*, an *exaggerated ability to hear oneself breathe and speak*. A patulous auditory tube may develop during rapid weight loss, or may be idiopathic. In contrast to a hypofunctioning auditory tube, the aural pressure is often made worse by exertion and may diminish during an upper respiratory tract infection. source: "Current Medical Diagnosis and Treatment", 45th Edition (2006), Tierney, McPhee, and Papadakis, published by Lange Medical Books/McGraw-Hill (Copyright