chemo induced hypothyroidism

[woodbeegood]

approx 30 wks into a 48 wk interferon/ribavarin therapy my thyroid went hypo-saw an endo and was put on synthroid-which i tolerate well-here it is 9 months after completing therapy and my thryoid functions have not returned to normal-lately there have also been changes in my voice-i am on the phone a great deal and people i talk with on a weekly basis have commented that i sound "different" kinda of hoarse or raspy? i have also noticed some swelling in the front of my neck-i mentioned these concerns at my last endo appt-but got no response at all from my dr other than she was surprised that my thyroid had not returned to pre-treatment status-my question is do you know if these drugs will cause permanent thryoid imparement? and should i be concerned about these other changes or just wait it out & see what happens? usually i can find the info i need via the web-but this whole thyroid thing seems so tricky, i can't make heads or tails out of the info i read-thanks so much for your time

[Mark Lupo, M.D.]

Interferon can cause thyroid problems in various ways.  If it induces an auto-immune attack on the thyroid - it may not be reversible.  I would check TPO and Tg antibodies to document this.

The hoarseness may be thryoid related - if there is a large goiter it can compress/irritate the nerve leading to the vocal cord.  I usually do an ultrasound of the thyroid to see if this is a likely possibility.  Other common causes of your symtpoms include sinus congestion with post-nasal drip and reflux of stomach acid (Yes, even if you don't have heartburn -- we call this silent reflux).  So - if symptoms persist - see an ENT to have a look at the vocal cords to get to the source of the problem.

[layla]

It is unusual for your thyroid to go back to pre tx function. Many people lose thyroid function to interferon tx and only a very few get it back. If it does come back you should know by now. You will most likely have to take thyoid meds continuosly. The voice problems you are having are probably to the incorrect dose. It takes a while to get adjusted. Your thyroid started going and that loss progresses differently for each person so just when you may think your feeling good a bit more of your thyorid function stops so once again you need an adjustment. Sorry to hear you lost your thyroid on tx. After all you go through  n tx to add the loss of a body organ is depressin. I had the same thing happen and know many more that had the same experience. The good thing is with the right dose of thyorid meds you will feel normal. I hope you made SVR.

[meling333]

HI
My thyroid went south on interferon tx.
In 02 and never returned. I have 3 types of antibodies now which I did not have before interferon. I had to go else where for tx, interferon dr. and his endo wouldnt do nothing for me. Just shoulder shurggers they were.
There is lots of info at pubmed on trials of interferon and thyroid illness. Also some good links on interferon and thyroid are at thyroidcom.          
If you cant find them email me
***@**** I am also being evaluated for Addisons and on cortef and doing much better these days.  Juanita

[woodbeegood]

thanks for the info-just so many variables & hate to be a hypochondriac or blame everything on the meds or what damage the virus may have caused-at the same time tho, don't want something missed that will cause issues down the road, ya know? yes so far so good on SVR-12 months at end of year-guess that'll be the "big" one. i really do feel alot better than pre tx-except for this little hiccup with the thyroid-no lasting effects as far as i can tell

[layla]

May this is a simple question but I have not been able to find the answer on the internet. I was told to take my thyroid meds on an empty stomach. How important is this and why? Does an emptly stomach mean no liquids? Thanks for any response.

[Mark Lupo, M.D.]

the importance is absorption of the medication - the more you have in the stomach to compete with absorption of the medication - the less it will be absorbed.  Drinking liquid with it is recommended so it does not get stuck in the food pipe - so a full glass of water (or anything liquid).

Ideally there should be at least 30min before food.  The key is to take it the same way everyday and not miss a day -- this gives the doctor the best opportunity to "fine-tune" the dose.

Other important issues are supplements such as multivitamins esp with calcium or iron -- I recommend taking thyroid in am and supplements after lunch or dinner.

[layla]

Thank you. I always worried that my coffee would be a problem.

[doll face]

wood- I too went hypo from the interferon. I am so glad to hear that the tx worked for you. It took me two tries but I am also SVR.

Layla- how many times have you had to increase your thyroid meds ? I know that mine have to be increased, but can't talk my doctor into it yet. He is is Michigan and I am in Tn. My tsh hovers around 2.2 which I have read is still too high especially for women. I can't even begin to list all the new different symptoms in the past two months. What dose are you on now? I guess that I will have to get a referal to an endo, since it is my pcp treating me. Good to see ya here.

[woodbeegood]

thanks-glad to hear you finally made SVR! one heckuva ride huh? thought after the sx from the meds-thyroid issues would be a piece of cake-geesh was i wrong on that one-i had no idea how much your thyroid affects you-still playing with my dosages also-guess it just takes time? do you happen to know if the thryoid will continue to "burn out" or will it maintain with what's left i wonder?

[doll face]

LOL Your right. I also thought thyroid issue would be nothing compared to tx. I can't seem to get my doctor to believe that I am still going through so much with this hypo.

I was told that as long as you are on the right dose of meds that your thyroid will be okay. But when they can't seem to find the right dose it makes you wonder. Plus if you  have to up your dose periodicly than doesn't that mean that the meds are not working as well any more. I am being treated still by my PCP. Did your hepatologist reccomend the endo? What dosage are you on?

I found quite a few interesting articles about the proper doseage.
http://www.allthyroid.org/disorders/treatments/changingmeds.html

and also many more that I can't get to right now as I am at work. A real good one about having to add T3 along with T4(synthroid) and keeping your TSH at the LOW end of the scale.

[woodbeegood]

Thanks for the links I will check them out-don't know why I can't seem to get a grip on this whole thyroid thing-maybe residual brain fog? lol My GI (tx dr) referred me to endo while still on tx-I was amazed at how much better I felt even on tx when the thyroid meds started working-seems like tho every couple months I'm increasing my dosage slightly-started at .5 daily then .5 daily and .75 every other day-right now I take .5 daily and every third day 1.0-supposed to go for more blood work this week & we will see where my #'s stand-may have to up it to 1.0 every other day-I guess the thing that concerns me most is the swelling in my neck & hoarsness in my voice that comes & goes-doesn't hurt just annoying-I still think it was a good trade tho

[layla]

Hi there. Good to see you too. I started on 25 levoxyl and was increased every 6 weeks to 100. At that point I was feeling better for almost 6 months then I started having extreme night sweats, nausesa and heart palps. I thought maybe too much meds. I also stopped periods, had headached and couldn't sleep at all along with some bowel problems. My doc thought is was probably premenopause but test said all was ok and I did not think that so I self lowered my meds and felt somewaht better. I still had some problems and went to my doc and told him. After giving me a "talking to" for doing my own thing he agreed to monitor me lowering med to see if it helped. I really lowered my meds a lot, to 25. I also made an appt with an endocrinologist who specialises in woman medicine. She took MANY test but didnt find anything. My TSH was about 2.8 and she had me increase my dose to 50. I just had a TSH and I bet I need another increase. I seem pretty sensative. At 4.5 I could hardly function. I imagine I need to be around 75 or so on levoxyl. I think this is all due to getting the right dose. The endo doc said our goal should be 1.0. She said most people feel best here and I think she is very good. I think I just truly wanted to beleive my thyroid was coming back and was going in that direction. Well I was wrong and just need to accept the loss and get at the right dosing. I think your right that 2.2 is too high. I can't wait to get this right, I am so sick of meds. Hope you get your adjusted soon. LL

[doll face]

I still think it was a good trade too...especially if I can get on the right dose.


Layla- Being out of state from my doctor is not helping matters here. At least my hep doc worked with me. The doctors here won't even talk to me about hep or thyroid issues because I am being treated from Michigan, so I have to rely on them getting my faxes and actually reading them. Ha.

My hep doctor started me on .50 mcg and my dosage has not been increased at all. I know that is whats wrong. Either an increase is needed or they need to add T3. But they need to do this soon, as I am miserable. At least on tx I knew that the sides would only last for a day or two at a time.


http://thyroid.about.com/cs/testsforthyroid/a/tyranny.htm

[layla]

The thyroid will continue to burn out but the progression is different for everyone so you really can't tell except by your labs and how you feel. Mine went very quickly, less than a year, while others can take many years. I think it is difficult when it takes long because you are always playing catch up. Just when your meds seem to be right you can lose more thyroid and need more meds. My believe my endo doc said the average med dose is either 100 or 125. LL

[layla]

Dam TSH. I got my labs back today and I am up to 3.7 after my last dose increase. Guess I was right about having symptoms that I was sure were not "all in my head". My endo doc called and increased me from 50 to 75 so we shall see how that goes. I am sure it must be fustrating being in Tn and working with a doc in Mi. The only good thing is you can get your labs anywhere and you will get to know where on the TSH scale you feel good regardless of what doc you are seeing. I have found the doc to be fairly on adjusting my meds according to how I feel (and the TSH). I hope you experience the same. LL

[doll face]

I finally got ahold of my hepatologist and explained that I couldn't get my PCP to send a lab request for blood work so he faxed me one. I had my blood drawn today so I should know something by tomarrow. My sister in law (in Michigan) goes to the same doctor there that I go through so she will bring in a copy of my blood results and talk to the doctor personally. If that doesn't work out than I will see if my hepatologist will just write me a script. Either way something WILL happen soon.

This is much harder to deal with mentally than tx right now. Hope you get your dosage right soon. I'll let you know how it goes with test results.