Here are the detailed results of my six month thyroid cancer check-up or details of a mixed bag type doctor's appointment...

first of all, the good news! i have been on a every six month thyroid cancer checkup schedule for the past EIGHT years. just to refresh any one's memory who  has not been following my blog, i had stage three papillary thyroid cancer, with an aggressive section of follicular thyroid cancer. two of my parathyroids were also cancerous, and had to be removed. the surgeon also removed eleven lymph nodes. the good news is that now i have graduated to once yearly ultrasounds. i still have to come back in six months for blood work and an office visit. read on for the reasons...

first, my blood work was a bit askew you might say. my t4 was 2.12 ( this labs range is 0.82 to 1.77)  and my t3 was 4.0( range of this lab is 2.0 to 4.4) my tsh was LESS THAN  0.006.( range of this lab is 0.450 to 4.5) . to quote a friend of mine, who summed up the feeling you have when your thyroid meds are too high, i felt like " a squirrel in traffic." what really got my attention though, was when my endocrinologist checked my heart. she said, " well, your heart is skipping a beat or two." she then reviewed my blood levels with me, and here is just one reason why i love my doctor. she looked at me and said; " what do you think we should do about this?" i know she knew, but she wanted to make sure that i was in agreement. i said, " well, i think we should reduce the Levoxyl that i take ( pure t4) from 137mcg to 125mcg. since i get very tired in the late afternoon, perhaps we could add 5mcg or so of Cytomel ( pure t3). just to review, our bodies metabolize the t4 into the t3- which is the energy that our bodies run on. synthetic thyroid hormone, like Synthroid, or the Levoxyl that i take, only consist of t4. sometimes, on a cellular level, our bodies do not, for whatever reason, make all of the t3 that we need. that is where the Cytomel(t3) comes in. now, if you are taking a naturally sourced thyroid hormone, like Armour thyroid or Naturethroid, the t4 AND the t3 are in one tablet. there is no one size fits all in the world of thyroid hormone replacement medications. here  is a pet peeve of mine: what works best for one, may not be the best choice for another. it is just part of the roller coaster ride one takes when trying to find the best type and dose of thyroid replacement hormone for them. and this changes, it seems, all of the time! we lose or gain weight, we get older, we are sick with other illnesses, are just some of the reasons that one requires a dosage adjustment.  whatever medication works for you, Hallelujah! i am certainly not going to suggest that you change to what works best for me. and please, vice versa.

moving on, my last blog discussed bone density, along with some other topics. my bone density test this time showed that my T scores are getting worse. to refresh, a normal T score is 1.0 or above.  osteopenia is defined by a T score of between -1.0 and - 2.5. and osteoporosis is defined as a T score of - 2.5 and below. my T score before had been 0.3, which put me in the mild osteopenia range. i went from 0.3 to - 1.2. still osteopenia, but creeping towards osteoporosis. what can one do for this? weight bearing exercise and  calcium and vitamin D supplements might help. i am already taking a prescription vitamin D. i had to stop my beloved Zumba classes due to a bad knee, and the fact that i had to have some time off  during my breast cancer surgery and chemotherapy. i have recently started Tai Chi classes, but that qualifies  more for balance and stress relief rather than any type of weight bearing exercise. i am still " studying on this" as my grandmother used to say. i do not have any answers to possibly improving, or sustaining, an acceptable T score.

so, my next blood work and office visit with my endocrinologist will be in february. i know this is a 2fer blog, and although i usually write about thyroid cancer related material, my next breast cancer check up will be coming up in november of this year. i will be relaying how that appointment went at the appropriate time. along with getting  a good breast cancer check up,  i am hoping for two more things to happen. first, that with the dosage adjustment in my thyroid replacement hormone, i will feel less like a " squirrel in traffic". secondly, that somehow my bone density will either stay the same, or better yet, improve.

Parathyroid function, hypoparathyroidism,osteoporosis- just another day in thyroid cancer world

Everyone has four parathyroid glands. These tiny glands- usually the size of a grain of rice- have a big function. That function is calcium and phosphorus  regulation in our bodies. That is their sole purpose in life- nothing else matters to them. The parathyroid glands are located behind the thyroid gland. Even though they share part of their name with the thyroid gland, they have no connection as far as what they do for a living. The thyroid gland regulates our metabolism, while the parathyroid glands, as stated, regulate calcium and phosphorus  levels. Why is calcium regulation so important? Calcium is the element that regulates the normal conduction of electrical currents along nerves. Calcium also causes muscles to contract. In fact, this is so important that the parathyroid glands are the only glands in the body that have the sole purpose in life just to regulate the correct amount of calcium and phosphorous in our bodies. The so called normal range of calcium is from 9 to about 10. We humans do not feel well if that level drops to below 9 or rises to above 10. Phosphorus regulation is important in that too much of this can hurt our kidneys. The parathyroids  can help the kidney eliminate excess phosphorus.

The parathyroid glands regulate calcium and phosphorous levels  by producing a hormone called parathyroid hormone, or PTH as it is known by its friends. If our calcium level drops, the parathyroid glands recognize this fact, and make PTH. This PTH goes to our bones and takes out some calcium, which then goes to our bloodstream. Our bones contain the majority of calcium for our bodies. There is also some calcium  in certain cells and some in blood and extracellular fluid.  When the parathyroids feel that the calcium level in the blood is correct, they take a break and stop making PTH.  A person can get by with one parathyroid gland, but we all need at least one. There are a few causes of hypoparathyroidism, but the major cause of this, and the only one that I will discuss, is hypoparathyroidism caused by thyroid cancer surgery, which results in removal of all of our parathyroid glands.  Some symptoms of hypoparathyroidism include: 

* tingling or burning in fingertips, toes and lips

* muscles aches or cramps in feet, face, abdomen

* twitching or spasms in muscles around the mouth or in the hands, arms and throat

*fatigue, weakness

* hair loss

*dry skin

*depression or anxiety

* in severe cases, there could be seizures or difficulty breathing. 

How is hypoparathyroidism treated? The doctor monitors the blood level of calcium, phosphorus ( too much phosphorus released by the bones can cause organ damage) and PTH. Low production of PTH in hypoparathyroidism, causes abnormally low calcium  levels in the blood and bones, and increased levels of phosphorus in the blood stream. 

Along with calcium supplements, a drug , Calcitrol, can be prescribed to treat hypoparathyroidism. Calcitrol is the active metabolite of vitamin D. The ways that  it works are by increasing the calcium that is released by the gut into the bloodstream, increasing the amount of calcium that is reabsorbed by the kidneys, and probably by increasing the amount of calcium that is released into the blood stream  by the bones.

Hypoparathyroidism is treatable, but it is a life long condition and can have serious complications. This is one example of why it is so important to have an experienced surgeon  doing thyroid cancer surgery. Please, please find out how many thyroid cancer surgeries that your potential surgeon has done, read reviews, and do your homework on the surgeon's technique, including how many patients he/she has had with hypoparathyroidism after surgery. 

A condition that is related to the above mentioned material, is osteoporosis. Osteoporosis can be  caused by several factors. Increasing age, a sedentary lifestyle, low estrogen in women, low testosterone in men, a deficiency of calcium and vitamin D, and high levels of thyroid hormone, just to name a few. How is osteoporosis diagnosed? By a bone density test, which measures how many grams of calcium and other bone materials are present in a section of bone. The bones most commonly tested are the hip and spine. Dense bones are good bones! Dense bones are less likely to break. Who wants a broken hip?

A bone density test is not painful. It is a fairly fast test- completed in about 10 to 15 minutes. It is best to wear loose clothing and avoid belts, zippers, and metal objects in pockets, etc. One thing that I was not aware of, is that it is best to avoid taking calcium supplements for at least 24 hours before the test. The amount of radiation that one is exposed to is very small. Much less than a chest x-ray, and I read on one site that a central DXA machine, which is the preferred test if your insurance will pay for it, has 10-15 times less radiation than a person receives on a round trip flight from New York to San Francisco! It is also recommended to use the same site/machine for subsequent bone density tests. This provides the doctor with a more accurate comparison of the results.

And how are the results expressed? The most commonly used test result is called a T-score. It is the bone density compared to the bone density of a healthy young adult of your sex. The following is a breakdown of the T-scores:

*  T-Score of  -1 and above :    Your bone density is considered normal

*  T-score of between -1 and -2.5 :  your score is considered osteopenia, ( below normal,) 

                                                

*  T-score of  -2.5 and below : considered to be osteoporosis

It is interesting to note that having low bone density or osteopenia does not mean that you will automatically have osteoporosis. If you lose bone in the future, or if your physician determines that you have what is called " fracture risk, or the estimate of the chance of a person breaking a bone" it may be determined that you need treatment for osteoporosis. It is not easy to determine if a person with osteopenia, or mild osteoporosis needs to take a treatment medication. These treatment medications have quite a few side effects, but certainly have their place in the hopes of preventing broken bones. 

In conclusion, the  parathyroid glands are extremely important to our bodies. It is an unfortunate consequence in some cases of thyroid cancer surgery, that one loses all of the parathyroids. Regardless of how many parathyroid glands that one does or does not have, it is important to have blood calcium tested and monitored by one's physician. And furthermore , along with the standard thyroid blood tests and calcium level tests, it would be prudent to have a bone density test every year or two. Know your numbers, keep a record of your tests, and most importantly, be your own best patient advocate.