Thyrotoxic Myopathy: A Primer for Patients with Hyperthyroidism

Despite the minute size of the thyroid gland, thyroid disorders have been linked to a broad range of symptoms and health problems that span virtually the entire body. The thyroid’s central role in regulating the endocrine system and the production and distribution of hormones throughout the body grant it a unique level of importance and influence that far exceeds its physical size.

Because of the complexity of thyroid-related health problems, researchers are only beginning to understand and document the full extent of some disorders that have their origins in thyroid dysfunction. One example is the neuromuscular disorder thyrotoxic myopathy, which is now recognized as having links to both Grave’s disease and hyperthyroidism. This week, we’ll take a look at the health implications for thyroid patients who are also diagnosed with thyrotoxic myopathy.

What is thyrotoxic myopathy?

Thyrotoxic myopathy is a neuromuscular disorder that is strongly linked to two common thyroid diseases, namely, Grave’s disease and hyperthyroidism. It is sometimes referred to by the alternate names of, Graves myopathy, Basedow’s myopathy, hyperthyroid myopathy, or Basedow paraplegia.

This disease is caused by excessive levels of the thyroid hormone thyroxine, which is a key symptom of both Grave’s disease and hyperthyroidism. Although research into the exact causes of thyrotoxic myopathy remains ongoing, it is believed that excessive production of thyroxine over extended periods of time can result in damage to the muscle fibers.

Some researchers have posited that the excess thyroid hormone can cause an array of problems in muscle components, including acceleration in several key muscle processes, such as lipid oxidation, mitochondrial respiration, and protein degradation. In addition, the presence of too much thyroid hormone can increase the muscle’s beta-adrenergic sensitivity.

Although there is also a type of myopathy that is related to hypothyroidism, it is much less prevalent than the type of thyrotoxic myopathy that is linked to hyperthyroidism and involves a different type of muscular failure.

What are the Symptoms of Thyrotoxic Myopathy?

Literally, the word ‘myopathy’ translates as ‘muscle disease.’ Thyrotoxic myopathy is but one of dozens of different types of muscle diseases. Although each myopathy is associated with a distinct symptom set, most share one major characteristic in common: muscular weakness and loss of muscle function and control. However, the onset of this muscle weakness can be very gradual, so that patients may not report it to their doctor for months or even years after it first becomes noticeable. Another common symptom of the disease is becoming tired and fatigued more easily.

The muscular weakness that is associated with thyrotoxic myopathy is often concentrated in the shoulders, neck area, and hips. In some cases, patients also report a sense of muscle weakness in the face, throat, and eyes. Without proper treatment, functions such as breathing, speaking, and vision can sometimes be adversely affected. The risk of vision problems is particularly high in patients with Grave’s disease.

In patients with chronic cases of thyrotoxic myopathy, the general severity of symptoms is often minimal to moderate. However, in rarer cases of acute thyrotoxic myopathy, the distress level can be intense. Over time, improperly treated cases of thyrotoxic myopathy can result in disintegration of the muscle tissue, a condition known as rhabdomyolysis. Some patients also experience bouts of temporary paralysis as a result of the disease.

Diagnosis, Treatment, and Prognosis of Thyrotoxic Myopathy

In some cases, achieving an accurate diagnosis of the disease can be challenging. This is particularly true in mild or moderate cases in which the onset of symptoms is very gradual. However, if patients have already been diagnosed with hyperthyroidism or Grave’s disease, physicians are usually aware of the risk that muscle-related symptoms can pose. Still, it is vitally important to report any increases in fatigue or weakness as soon as they are noticeable.

Like many disorders that have their origins in thyroid dysfunction, most of the symptoms of thyrotoxic myopathy can often be reversed if patients adhere closely to their prescribed regimens of thyroid medication. Because an excess of thyroid hormone causes this disorder, taking medication to balance thyroid hormone levels can often, in effect, “cure” the symptoms of thyrotoxic myopathy.

In most cases, problems with muscular weakness and general fatigue can be eliminated in less than six months after thyroid levels have been balanced through medication. However, it may take as long as a year of treatment for muscles to regain any lost tissue or muscle mass.

Compared to many other thyroid-related disorders, the prognosis for thyrotoxic myopathy is quite good. If patients remain consistent in their adherence to prescribed medications, it is likely that they will soon be able to regain their full health and well-being.

For Further Reading

• http://www.mdausa.org/publications/fa-myop-qa2.html

• http://www.emedicine.com/neuro/byname/endocrine-myopathies.htm

Coping With Migraines: Tips and Strategies for Thyroid Patients

Thyroid patients know that dealing with all of the symptoms that stem from their condition can be a proverbial “pain in the neck,” but for many, it can also lead to pain in the head -- literally. For reasons that researchers are still working to uncover, thyroid patients are often much more prone to migraine headaches than the general population.

While all headaches can be painful and inconvenient, the symptoms associated with migraine headaches -- including nausea, light sensitivity, and extreme discomfort -- are often so severe that they make normal tasks and activities virtually impossible. When added to the challenges of navigating life with a thyroid disorder, the added strain of coping with migraine headaches can be daunting.

This week, we’ll explore the connection between thyroid disorders and migraine headaches. We’ll take a look at the causes and symptoms of migraines, the origins of the link between migraines and thyroid-related illnesses, and treatments that thyroid patients can rely on to reduce both the symptom intensity and frequency of migraines.

What is a Migraine Headache?

Believe it or not, this is a question that is still the topic of some debate among scientists and researchers. Because the experience of pain is such a personal sensation, and because migraine symptoms tend to vary from person to person, the clinical definition of migraine headaches has been somewhat difficult to pin down.

Most researchers, clinicians, and headache sufferers alike can agree on one thing: the migraine is one of the most severe types of headaches, often resulting in near-paralyzing pain in the head and along the temple. However, where migraines differ from other types of headaches is in the fact that they are also often accompanied by a host of other symptoms, including:

• nausea and vomiting

• inability to work or perform simple tasks

• an aversion to loud noises

• photosensitivity (avoidance of sunlight, lamps, or other artificial lighting)

• a strong desire to lie down and remain motionless

• a throbbing sensation in the head and neck

Often, migraine sufferers experience a sensation called an “aura” in the hours before the onset of a headache. This results in a sensation of flashing lights, spots, or zigzags in the field of vision. In some cases, vision may be temporarily limited or lost during the pre-migraine aura.

Migraine headaches are often more intense and long-lasting than other types of headaches. Although they can last for as little as 1-2 hours, they often stretch for as long as 2-3 days. After the pain of a migraine has receded, sufferers often have to deal with a lingering sense of illness and malaise in the aftermath of the headache.

Can Thyroid Disorders Cause Migraines?

At this point, researchers remain unsure about the exact cause of migraine headaches. While there are several prevailing theories that have sought to explain the origins of these headaches, research on the subject has been inconclusive. At the current juncture, it is unclear whether a single, conclusive cause for migraines will ever be discovered.

However, it does seem that thyroid patients tend to suffer from migraines more frequently than those who do not have thyroid disorders. One common hypothesis contends that hormonal changes may trigger migraines, and because the thyroid gland is part of the endocrine system, which is responsible for dispensing and regulating hormones within the body, researchers believe that this link may be significant.

Specifically, some researchers have posited that thyroid hormones interact with serotonin and noradrenalin, two of the chemical compounds that are related to migraine headaches. Although the precise mechanism of this interaction remains unclear, it is suspected that it may explain the heightened frequency of migraines among patients with thyroid disorders.

Treating and Preventing Migraines: An Action Plan for Thyroid Patients

Migraine headaches are notoriously stubborn and resistant to treatment. Although some effective pharmaceutical treatments for migraines have been developed in recent years, doctors recommend prevention-oriented strategies as the best way to reduce the harmful impact of migraines in your life.

Complete prevention may be impossible, especially if the “trigger” that is causing your migraines is hormonal or chemical in nature. However, by following these steps, you may be able to significantly reduce the number and intensity of migraines you experience.

• Practice good adherence to your prescribed thyroid medication. This will help eliminate large hormonal and chemical variances that could trigger a migraine attack, not to mention keeping your other thyroid-related symptoms in check.

• Determine whether you have any other triggers that may be setting off your migraines. Frequent culprits are common foods and beverages, such as alcohol, nuts, or chocolate. Get into the habit of keeping track of your daily food intake in a journal. If you have a migraine, you may be able to identify your triggers by analyzing what you ate and drank in the days before the attack.

• At the earliest onset of a migraine “aura” or the tell-tale pain, take the medication that your doctor has prescribed for you. For many patients, a dose of aspirin and several cups of coffee may do the trick (although you should clear this with your physician before you try it).

• If the migraine becomes severe, don’t be afraid to seek emergency intervention. ER personnel have solutions that can significantly decrease the intensity of a migraine headache.

• Develop a personal action plan with your doctor well before a headache hits, so that both you and your family will know what to do when the symptoms begin.

For Further Reading

• http://www.helpforheadaches.com/articles/thyroid_and_migraine.htm

• http://headaches.about.com/od/bookreviews/fr/ThyroidHormone.htm

• http://www.thyroid.ca/Guides/HG13.html

Thyroid News and Recent Research Breakthroughs

Awareness of the once rarely-discussed thyroid gland is one the rise. As the thyroid’s central role in regulating everything from weight to mental health is becoming more widely recognized, the public -- and the news media -- are beginning to pay more attention. This week, we’ll take a look at a roundup of some recent thyroid news and research.

Research Shows Varying Links Between Smoking, Thyroid Disorders

Even as awareness of thyroid disorders has increased considerably in recent years, the public’s awareness of the health risks of cigarette and tobacco use has also increased. Today, the rate of tobacco use is at an all-time low. Still, researchers estimate that approximately 30% of the adult population in the United States uses cigarettes and tobacco products every year. In other countries, the rate of cigarette and tobacco use remains much higher.

A recent study published in the prestigious scientific journal The Annals of Internal Medicine sought to shed some light on the relationship between tobacco use and thyroid disorders. The investigation analyzed the health data of more than 30,000 men and women who had been diagnosed with various thyroid disorders.

The study found that smokers were more likely than non-smokers to have developed an overactive thyroid gland, otherwise known as hyperthyroidism. However, smokers were less likely to develop excessively slow thyroid function, known as hypothyroidism.

According to these results, several of the chemical compounds in tobacco smoke seem to interact with thyroid function However, some of the symptoms of hyperthyroidism seemed to recede when smokers quit using tobacco, suggesting that the results of this interaction may be reversible, at least to a certain degree.

Cosmetic Surgery Techniques Yield New Thyroid Surgery Advances

Although thyroid surgery is often the most effective treatment for a variety of thyroid disorders, the surgical procedures used can be challenging and complex. Also, because the surgical incision is often made in the delicate skin of the neck, some unsightly scarring was long thought to be inevitable.

Thanks to the efforts of a team of researchers at the Medical College of Georgia, many of these longstanding difficulties may be overcome in the near future. The team undertook a series of experiments in which new and emerging surgical techniques first developed by cosmetic surgeons were incorporated in thyroid surgery.

The team applied several standard procedures that are used in cosmetic surgery in the surgical procedures of nearly 250 men and women with thyroid disorders. These techniques included having the patient sit or stand when marking the area in which surgery was to be performed, using smaller incisions, creating symmetrical scars with smoother lines, camouflaging scars in naturally-occurring skin folds, using surgical glues instead of sutures or staples, and reducing or eliminating the use of surgical drains.

According to the researchers, these techniques all produced increased patient satisfaction over traditional methods of thyroid surgery. Furthermore, only one of the patients needed to receive additional cosmetic treatment for unsightly scars after the procedure. Although these techniques have not yet been widely incorporated, it is likely that they will shape the future development of thyroid surgery.

Environmental Link to Thyroid Cancer Bolstered by Outbreak Among Ground Zero Workers

One of the most confounding public health mysteries to emerge in recent years has been the skyrocketing rate of certain once-rare thyroid cancers in the United States. Although researchers have not yet reached a consensus on the cause of this alarming trend, many public health advocates and thyroid health activists have contended that environmental factors such as pollutants may be playing a role in the problem.

While this contention remains controversial, it appears to be supported by recent reports that a disproportionate number of the firefighters and first responders who worked on the clean-up of the World Trade Center site in the aftermath of the 9/11 terrorist attacks have since been stricken with a rare form of thyroid cancer.

According to recent media reports, eight cases of the disease have been diagnosed among the relatively small group of male firefighters who served during the 9/11 response and aftermath. In addition, five other male firefighters have undergone preventive thyroidectomies after pre-cancerous cells were detected. This rate of diagnosis far exceeds the typical epidemiological pattern of thyroid cancer, which only strikes four people per 100,000, and is usually diagnosed in women.

While this trend does not definitively prove a link between environmental pollutants and thyroid cancer, it does seem to strongly suggest that such a connection may exist. Check back weekly for the latest updates on breaking thyroid news and research developments.

The Truth About Radioactive Iodine Therapy: A Primer for Patients with Hyperthyroidism or Thyroid Cancer

If you’re like most people, the mere mention of the word ‘radioactive’ may have you making a break for the nearest fallout shelter. For those of us who lived through the Cold War and the stories of widespread environmental pollution that dominated the media in the 1980s and the 1990s, the word doesn’t exactly bring to mind visions of health and well-being.

Surprisingly enough, though, not all types of radioactivity are harmful. A number of important diagnostic tests and medical treatments rely on radioactive substances in order to work properly. In fact, if you or someone you know has been diagnosed with an overactive thyroid or one of certain types of thyroid cancer, the chances are good that one important part of your treatment will involve one or more doses of radioactive iodine.

Although the idea of getting shot with a dose of radioactive material sounds scary, this is actually one of the most effective -- and fast-acting -- ways to slow down an overactive thyroid gland and help your body get back on the path to wellness. This week, we’ll take a look at radioactive iodine therapy and its special role in the treatment of hyperthyroidism and thyroid cancer.

What is Radioactive Iodine Therapy?

Iodine is a chemical element that plays an important role in fostering healthy growth and development. Without sufficient levels of iodine in the diet, proper development can be stunted. The thyroid gland, in particular, needs a steady supply of iodine in order to function properly. The large thyroid growths known as goiters are a common result of iodine-poor diets.

All ingested iodine is processed through the thyroid gland. In fact, the thyroid is the only bodily organ that can break down iodine and use its chemical components. Because of this unique property, doctors have found that iodine-based treatments are often highly effective methods of delivering targeted treatment to the thyroid gland.

For this treatment, a small dose of iodine is made radioactive. Depending on the disorder that is being treated, the form of radioactive iodine that is taken differs from patient to patient. However, most people are given radioactive iodine either in a capsule that is ingested orally, or in shot.

For patients with hyperthyroidism, a single dose of the radioactive iodine may be all that is necessary to cure the disease. For patients with thyroid cancer, this form of treatment destroys cancerous thyroid tissue, as well as stray thyroid cells that may have moved elsewhere in the body. For both of these diseases, this treatment is highly effective.

What are the Side Effects, Symptoms, and Risks of Radioactive Iodine Treatment?

Because the thyroid is the only organ that can process iodine, the radioactive iodine poses virtually no risk of adverse outcomes or side effects. However, this treatment involves the ingestion of a very potent substance, and as such, it is not uncommon to experience a few adverse symptoms in the days and weeks following a dose of radioactive iodine. These include:

• Inflammation of the Thyroid. This is the most common complaint of patients who have gone through radioactive iodine treatment. As the thyroid gland processes the medicine, swelling and tenderness in the area is often unavoidable. Doctors refer to this temporary condition as ‘radiation thyroiditis.’ In the vast majority of cases, this inflammation will subside within several days.

• Possible Reproductive Side Effects. Both radioactivity and thyroid imbalance can have negative effects on a developing fetus, and as such, both men and women who have undergone radioactive iodine therapy are strongly encouraged to delay conception in the months following treatment. Typically, a period of six months will be sufficient to ensure safe conception. Also, because small amounts of the radioactive iodine may be excreted in breast milk, lactating mothers are often encouraged to choose an alternate treatment option.

• Eventual Hypothyroidism. Most experts agree that radioactive iodine treatment is the single most effective therapy available for patients with overactive thyroid glands. In fact, sometimes the treatment can work a bit too effectively, transforming overactive thyroid glands into underactive thyroid glands. If this occurs, you may have to take hypothyroid drugs to restore proper balance to your thyroid function.

Even taking these potential risks into consideration, radioactive iodine therapy is still one of the best treatment options for patients with hyperthyroidism or certain types of thyroid cancer. If your medical team has suggested this course of treatment, you can be confident in the knowledge that radioactive iodine therapy has a great track record of offering rapid, effective results with very little risk. Sometimes, a little radioactivity is just what the doctor ordered!

For Further Reading:

• http://health.yahoo.com/ency/healthwise/hw148148