Saturday, July 20, 2019

Fatigue is not my friend...can anything help?

 Before I had thyroid cancer/ surgery/the  I-131 treatment, I thought  I knew what it was to be tired. Working full time and raising two children, two very active children, was wonderful, but exhausting. My husband has always been a" hands on dad", now he is a " hands on granddad", but there are still some things that only Mimi can do.  There is nothing quite like being " hypothyroid tired", though.

That is what all of us who have had thyroid cancer, and our thyroid glands removed, are now: hypothyroid to the extreme. Even a thyroid gland that is not functioning quite properly, still usually produces a little thyroid hormone. And even with the best thyroid hormone medication supplementation, this is not comparable to a fully functioning thyroid gland. I know that I am preaching to the choir  here, so this is not new information. Can we, as thyroid cancer survivors, do anything to help ourselves be less tired, and more able to enjoy our lives?

There are a few things that could help us get our groove back. Some involve lifestyle changes, and some may involve medication changes. Of course, if you are like me, medication dosage changes are just a way of life now. Unfortunately, it is not a " one pill and you are done" kind of thing. Constant blood tests and monitoring are lifelong events for us now. It is very important to see a physician who understands the dynamics of thyroid hormone dosing for thyroid cancer patients. Our overall health, weight, lifestyle, and other changes affect the way our thyroid medication works and how effective our dose is.

Five years after my thyroid cancer, I had breast cancer. I went through bilateral mastectomies and three months of chemotherapy. I lost twenty plus pounds due to the chemotherapy drugs. As you can imagine, my thyroid levels were all over the place. My doctor reduced my thyroid hormone dosage, but I still needed an adequate dose so that I could power through everything that was happening in my life. I am at the age now when osteoporosis is a concern. I have osteopenia- which means that I may develop osteoporosis at some point. Two factors come into play here. One is the chemotherapy drug that I take every day to prevent a breast cancer recurrence can cause bone loss. Added to this is the drug, Cytomel( T3),which  may also cause bone loss. I take a very small dose of Cytomel once a week. The reason for this is that my endocrinologist has reduced my Levoxyl ( T4) dose to one-half tablet once weekly ( six days a week, I take a whole tablet). T3 is the energy part of the thyroid hormone formula. Our bodies are SUPPOSED to convert T4 into T3. If this process is flawed in any way, a person may  feel extremely fatigued. T3 supplementation can really help boost our energy , but it does come with a cost- especially as we get older.

The take away from this information is this. If you discover, from blood work testing, that your T3 is low, you may want to talk to your physician about supplementing your T3. There are a couple of ways to do this. You and your doctor may decide that you can stay on your T4 only drug ( Levoxyl, Synthroid, generic levothyroxine,etc) and add some Cytomel ( T3) OR you may decide to try a naturally derived medication like Armour thyroid, which contains both T3 and T4 in one tablet. Besides possible osteoporosis, too much T3 can possibly  cause or  worsen  heart arrhythmias. Because of this, not everyone can take supplemental T3. As I mentioned, it is something that needs to be discussed with your doctor before you decide that it is safe/effective for you.

There are other things that everyone can do to help boost our low energy levels. One is to make sure that our thyroid medication, whatever type you use, stays cool. Heat will break down thyroid medication, making it less effective. With the heat wave sweeping our country right now, make sure to keep your medication in a cool place. It seems to be especially true for the naturally sourced drugs. When I was practicing pharmacy, I always recommended that people keep their natural thyroid medications in the refrigerator ( you do not want to push the bottle to the back of the fridge, though. it might freeze!) Refrigeration also helps keep down the smell of naturally derived thyroid medications. If you are traveling this summer, keep your medications in the air conditioning ( your purse, for example) or in a cooler if that is not possible. And for those that mail order their  medications, I would request that the company send your medications out with a refrigerated ice pack. Also, do not let these drugs sit in a hot mailbox! I know someone who mail ordered her thyroid medication and it sat in a hot mailing room as well as the mailbox. Her TSH skyrocketed ! When she figured out what had happened, she made sure to keep her medication from getting too hot.

It is easy to say, but getting extra, or at least adequate sleep is very important. Another thing is move! Exercise sometimes seems like the last thing that a thyroid cancer patient would be able to do, but exercise can actually boost your energy levels. A brisk walk is great- only do it early in the morning or in an air conditioned place. Since we are missing our thyroids, we are especially sensitive to heat (as well as cold. )

Before I had thyroid cancer, if I was very tired but needed to do something, I could push myself to accomplish whatever task I needed to do. That is not true for me anymore. If I am truly tired, I find that I can not " push through". I just hit a wall, and can not make myself go forward. This is something that I think is very hard for those who have a thyroid to understand. I have had to accept the fact that there are times my body is telling me, yelling at me, to rest, and I have to do that. I have to prioritize my activities and I do have limits now.

Some people take vitamins and supplements to help boost energy. I am not sure that these work, but if they seem to work for you, go for it. The only thing that I would never, ever recommend is an energy drink/product. These are very harmful and high doses of caffeine and can be extremely dangerous for certain people. Besides, what goes up, must come down, and usually it involves a crash.

I wish that I had the magic cure for fatigue. I still struggle with this despite my best efforts. Eating well, getting enough sleep, exercising, finding joy in life and expressing gratitude have helped me. I do not always follow my own good advice, but I am trying. One other tip- it is just fine to take a nap!