Issue 4: Lack of regular (or any!) thyroid ultrasound testing

Ultrasound
Thyroiditis? Get an ultrasound! Image: “Ultrasound station” by Michael Coghlan, August 16, 2012, from https://flic.kr/p/cToEsJ

This series of 6 blog posts tells my story and outlines the six challenges I’ve faced.

This post focuses on the importance of ultrasound imaging in the diagnosis and management of hypothyroidism, especially autoimmune thyroid gland disease.

At almost every turning point in my experience with Hashimoto’s thyroiditis, I have had to do my own research and take initiative to ask my doctors for tests that should have been done years earlier.

On top of my hypothyroid symptoms (during treatment as well as pre-treatment) and the fact that chronic hypothyroidism increases risk for other health issues (such as heart problems), I have struggled with systemic barriers in the health care system:

  1. Delayed diagnosis of hypothyroidism
  2. Misdiagnosis of thyroid-related depression
  3. Ignorance of Hashimoto’s autoimmunity
  4. Lack of regular (or any!) thyroid ultrasound testing
  5. Lack of testing for Free T3 and Reverse T3 levels
  6. Lack of referral to an endocrinologist who understands

Continue reading “Issue 4: Lack of regular (or any!) thyroid ultrasound testing”

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Issue 3: Ignorance of Hashimoto’s thyroiditis autoimmunity

Hashimoto's Thyroiditis
Hashimoto’s Thyroiditis: an autoimmune condition.

This series of 6 blog posts tells my story and outlines the six challenges I’ve faced.

This post focuses on the importance of understanding and diagnosing a special type of hypothyroidism, Hashimoto’s thyroiditis, which is actually the most common cause of hypothyroidism.

At almost every turning point in my experience with Hashimoto’s thyroiditis, I have had to do my own research and take initiative to ask my doctors for tests that should have been done years earlier.

On top of my hypothyroid symptoms (during treatment as well as pre-treatment) and the fact that chronic hypothyroidism increases risk for other health issues (such as heart problems), I have struggled with systemic barriers in the health care system:

  1. Delayed diagnosis of hypothyroidism
  2. Misdiagnosis of thyroid-related depression
  3. Ignorance of Hashimoto’s autoimmunity
  4. Lack of regular (or any!) thyroid ultrasound testing
  5. Lack of testing for Free T3 and Reverse T3 levels
  6. Lack of referral to an endocrinologist who understands

Continue reading “Issue 3: Ignorance of Hashimoto’s thyroiditis autoimmunity”

Issue 2: Misdiagnosis of thyroid-related depression

Depression
Low thyroid hormone levels can cause depression symptoms. Image: “Depression,” by Poughkeepsie Day School, April 19, 2012, from https://flic.kr/p/bPyAjv

This series of 6 blog posts tells my story and outlines the six challenges I’ve faced.

This post focuses on misdiagnosis of hypothyroid-caused depression, specifically the wrong assumption that all depression must be treated with antidepressant medication.

At almost every turning point in my experience with Hashimoto’s thyroiditis, I have had to do my own research and take initiative to ask my doctors for tests that should have been done years earlier.

On top of my hypothyroid symptoms (during treatment as well as pre-treatment) and the fact that chronic hypothyroidism increases risk for other health issues (such as heart problems), I have struggled with systemic barriers in the health care system:

  1. Delayed diagnosis of hypothyroidism
  2. Misdiagnosis of thyroid-related depression
  3. Ignorance of Hashimoto’s autoimmunity
  4. Lack of regular (or any!) thyroid ultrasound testing
  5. Lack of testing for Free T3 and Reverse T3 levels
  6. Lack of referral to an endocrinologist who understands

Continue reading “Issue 2: Misdiagnosis of thyroid-related depression”

Issue 1: Delayed diagnosis of hypothyroidism

Blood-tests
Get tested for hypothyroidism! Image credit: “IMG_9036” by Neeta Lind, May 27, 2009, from https://flic.kr/p/6rBfs2

This series of 6 blog posts tells my story and outlines the six challenges I’ve faced.

This post focuses on the delayed diagnosis of hypothyroidism.

At almost every turning point in my experience with Hashimoto’s thyroiditis, I have had to do my own research and take initiative to ask my doctors for tests that should have been done years earlier.

On top of my hypothyroid symptoms (during treatment as well as pre-treatment) and the fact that chronic hypothyroidism increases risk for other health issues (such as heart problems), I have struggled with systemic barriers in the health care system:

  1. Delayed diagnosis of hypothyroidism
  2. Misdiagnosis of thyroid-related depression
  3. Ignorance of Hashimoto’s autoimmunity
  4. Lack of regular (or any!) thyroid ultrasound testing
  5. Lack of testing for Free T3 and Reverse T3 levels
  6. Lack of referral to an endocrinologist who understands

Continue reading “Issue 1: Delayed diagnosis of hypothyroidism”

Low-T3 syndrome and angina

Low-T3-heart
When deprived of T3 hormone, the heart suffers

Low-T3 Syndrome—associated with angina or myocardial infarction: Although studies on Low-T3 syndrome usually focus on patients with “normal” thyroid glands and explicitly exclude patients with thyroid disease and/or on T4-therapy, the dysfunction of thyroid hormone equilibrium is also relevant to patients who suffer from Low-T3 while on T4-therapy despite having a normal TSH.

Continue reading “Low-T3 syndrome and angina”

Aortitis in Ankylosing Spondylitis

This blog post features recent articles that may offer explanations of the connection between aortitis and Ankylosing Spondylitis.

It’s challenging for doctors and patients to understand what is going on when two conditions present together. Some doctors might attribute the arthritic pain to non-infectious costochondritis (“inflammation of the costal cartilage, the structure that connects each rib to the sternum at the costosternal joint” [Wikipedia: Costochondritis]) and not look further into the deeper vascular phenomena also associated with Ankylosing Spondylitis.

If the aorta is the problem and not the heart itself, will troponin levels be elevated? Not always, according to the case presented by Looi, et al (2011).

In some cases an ECG reveals a problem, and this at least will engage heart specialists.

But what about cases in which the aorta is inflamed in the thoracic or abdominal areas, not near the septum or aortic valve?  What about “periaortitis,” as described below by Palazzi, et al? Will the symptoms of periaortitis likely register as a possibility in the minds of emergency specialists or rheumatologists?

Continue reading “Aortitis in Ankylosing Spondylitis”

What we’ve known for 90 years regarding hypothyroidism and angina

What we’ve known for 90 years regarding hypothyroidism and angina … has apparently been forgotten or never introduced to the newer crop of physicians, including cardiologists.

In the past six weeks as I have experienced daily angina pains for the first time in my life, I have met several physicians, including a cardiologist and emergency doctors who, when examining me, have said that it’s not likely my angina symptoms were caused by an increase in T4 dose, despite the twice-repeated coincidence of distressing angina fast following increases in T4 dose. The doctors have sometimes told me that in order to experience thyrotoxicosis that harms the heart, you have to have extremely high T4 values above the lab reference range, which I haven’t got. You can read more about my experience in another post.  But first…

Really?  Is angina only caused by being HYPER-thyroid?  Where did they get this idea…

Yes it can also be caused by T4-therapy in HYPO-thyroid patients, according to the literature. Continue reading “What we’ve known for 90 years regarding hypothyroidism and angina”

Thyroxine monotherapy and poor T4-T3 conversion

I recently found an excellent 2015 article focusing on the phenomenon of “poor conversion” from T4 to T3 thyroid hormones in hypothyroid patients treated with thyroxine (T4, Synthroid).

  • Midgley, J. E. M., Larisch, R., Dietrich, J. W., & Hoermann, R. (2015). Variation in the biochemical response to l-thyroxine therapy and relationship with peripheral thyroid hormone conversion efficiency. Endocrine Connections, 4(4), 196.

Their study was based on 353 subjects on T4-only therapy who had reached a stable “euthyroid” status (defined as TSH <=4.0 and fT4 >10pmol/l).  Their subjects were divided into three categories:

  1. patients who had had carcinoma (who had had thyroid surgery and were taking a large dose of T4 in order to suppress TSH),
  2. patients with “AIT” (autoimmune thyroiditis), and
  3. patients who had had non-cancerous “Goitre” (after surgery to remove thyroid nodules).

Continue reading “Thyroxine monotherapy and poor T4-T3 conversion”

Tingling sensation from electrode on heart monitor

When I was on a 48-hour holter monitor for my heart, I occasionally noticed a tingling electric-like sensation emanating from one of the electrodes into the skin under it. The little zaps pulsed for about 1 minute and then faded away.  Both times it was the same electrode in the same location.

It was not a feeling of itching or skin irritation like an allergic reaction, but a distinct sensation of tingling like low-level electricity.  It was very distinct from the deeper chest pains I have been recording in my heart monitor log.

My husband (who is an expert in electronics) suggested that even a little moisture, possibly secreted by sweat, or by the skin having an allergic reaction to contact with the electrode, might have caused this.

After the electrodes were taken off, the most reddened skin appeared under the electrode that tingled the most.

I can’t find anything about this online through random Google searches and I don’t have time to research it further right now.  I wonder if anyone else has experienced this.

Hypothyroidism and Angina: Research

Although it is more common to consider angina in relation to hyperthyroidism, several articles have reported angina appearing in hypothyroid patients when treated with exogenous thyroid hormones (T4). They recommended gradual increases in T4 dosage, but mentioned that a satisfactory dose may not be achievable, leaving patients to accept a compromise between hypothyroidism and angina.

Continue reading “Hypothyroidism and Angina: Research”