Thursday, February 21, 2013

WHAT ARE THOSE PESKY LITTLE PARATHYROIDS, AND WHAT THE HECK DO THEY DO?y

i like to joke around a little and say that two of my parathyroids left me  and moved to Paraguay!  ( i guess that is easier than the truth- that two of my parathyroids were cancerous and had to be removed). it was then and only then- you know the saying, you only miss something when it is gone- that i really started to think about our parathyroids. what  are they, what do they do, and why are they soooooo important?

well, they live near our thyroid gland- hence the name parathyroids. a fun fact, if you are a science nerd like me, is that most people have four of these, but some people have three, or even up to six! it would be sort of hard on the little guy, but you actually can get by pretty well with just one parathyroid gland. you do need at least one, as i said. if you happen to think being hypothyroid is difficult, being hypoparathyroid  seems ( to me, anyway) to be worse. the symptoms of hypoparathyroidism are as follows: muscle cramps/spasms,numbness or tingling in the hands or feet, tingling of the lips and in worst case scenarios, seizures. uh, no, thank you. 

our parathyroids are small glands near our thyroid glands. they look a little like a lumph node,  and they produce  a hormone called( and brilliantly, i might add) parathyroid hormone, or PTH. our parathyroids  do NOT make  thyroid hormone, but the PTH they produce  regulates the calcium in our bodies. the PTH also increases the activation of vitamin d in our bodies. i could get more involved here, but i think you get the idea. as long as we can hang onto one parathyroid gland, life is good. if there is cancer present in all of the parathyroids, or you unfortunately get a surgeon who is not skilled in saving the little guys,  then hypoparathyroidism occurs. hypoparathyroidism can be treated of course, with mega doses of calcium and a drug called calcitriol, which helps with the absorption of calcium. needless to say, people who have hypoparathyroidism need to have their calcium levels checked regularly. there is also a more sensitive test for measuring calcium -it is called an ionized calcium level, which is usually reserved for those people dealing with hypoparathyroidism. 

well, now, kind of makes you appreciate those parathyroid glands. who knew, right? after my surgery, my surgeon was afraid that the blood supply had been cut off to my remaining two parathyroid glands. i was given large doses of IV calcium in the hospital, as well as calcitrol, and 12,000mg, yes, i said 12,000mg, of calcium per day. he prescribed this for one month, and then checked my calcium level. so far, my two remaining parathyroids are working pretty hard. my calcium level runs a little low, but is not in the hypo range. an interesting side note- when i asked my surgeon where he put my parathyroid glands since my butterfly had flown away, he said that he " just threw them back in there". i never got the answer to my question, but i would imagine that they are attached to some friendly " vessel". interestingly enough, sometimes the surgeon will put them in a patients forearm. i am not sure why this would be a good idea, but it would provide easier access i guess. regardless of where they are placed or " thrown back into" they need a good blood supply to pick up the PTH and get on with the business of regulating  calcium levels  in our bodies. 

so, now you know all about our parathyroid glands. next time, i will probably discuss TED( thyroid eye disease)- which is a new( to me, i just found out about it ) hypo/hyper thyroid symptom. i will also talk about eye watering from the I-131 treatment. how do you tell the difference? i am not sure, but we will " see" what happens. 


Sunday, February 10, 2013

"low vitamin d levels and the hypothyroid connection". here is my disclaimer: no scientists were harmed in the writing of this blog. the opinions expressed are solely those of the author. ( hint: me)

 for some time now, i have been fascinated by the connection between low vitamin d levels, and hypothyroid disease- especially thyroid cancer. i have experienced low vitamin d  myself, and have known countless patients who have low vitamin d levels and also have hypothyroid disease or thyroid cancer.

just to review, vitamin d is so important for the body because it  aids in the absorption of calcium and phosphorous, which is important for strong bones. since this vitamin seems to be the " it" vitamin right now, research is being conducted on the importance/ roles  of vitamin d in our body. new studies on the benefits of  good vitamin d levels and the effects on  our bodies seem to be coming out every day.  an  adequate level  of vitamin d is  important for strong bones, and may be helpful in reducing high blood pressure, and  protecting us from some cancers- especially autoimmune ones( hint: thyroid). vitamin d is also thought to help prevent colon cancer, breast cancer, and one study finds that some patients with blood cancers have much improved survival rates with optimal levels of vitamin d. ( this study was cited by the mayo clinic website, if you want additional information on this).

what is an optimal level of vitamin d? it gets tricky here. doctors differ on what they think  is the optimal range, and of course testing from lab to lab varies. i will quote an article from the mayo clinic website which states that " in routine health check ups, between one- fourth and one-half of patients seen have vitamin d levels below the optimal range". i will now just throw out the range that my lab uses: from 30 to 80 ng/ml is the optimal range. my doctor feels that thyroid cancer patients should have a value of at least 60ng/ml. a level   over 80ng/ml may cause some kidney problems, so one needs to stay in the correct range. taking the correct dose of vitamin d  and having the vitamin d level checked is very important. the over the counter supplements come in doses up to 5,000 units. the prescription dose, and the dose i am currently on, is 50,000 units. this is taken once or twice a week, depending on the patient's level  and what the physician feels is appropriate therapy.

several years ago, when i was sick, and before the doctors knew what was wrong with me, my doctor checked my vitamin d level. it was less than 10ng/ml. that is obviously very  low, and probably was a first indicator( i think) that i might have cancer. i want to personally encourage all those patients with thyroid disease, especially thyroid cancer, to please get your vitamin d level checked, if you have not done so already.

it is also important to get adequate sunlight so that vitamin d can be activated in our bodies. i read somewhere that as little as 15 minutes a day is probably sufficient. today, we all rush to work before daylight and get home after dark. it is especially hard to get any sunlight exposure in winter. and the wide use of sunscreen makes it difficult for our bodies to get the sunlight that we need to convert vitamin d to its active form. i feel that, especially since i have also  had skin cancer, sunscreen is an essential part of good health care. so please do not stop using sunscreen!

another part of the calcium/vitamin d connection is our parathyroids. i really get excited talking about the parathyroids! this will be an entire blog- for next time. i also want to talk about a side effect of the I-131-which is  constant eye watering. this is something that i have just discovered, and in a related topic, there is TED, or thyroid eye disease. this is present in both hypo and hyper thyroid disorders. and how do you know, if you have had thyroid cancer and the I-131 treatment , if you have eye watering from the I-131 or you have TED? maybe by presenting the facts that are known about each, it will make things look a little clearer( no pun intended; well, maybe just a little).