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Suggest Treatment For Extreme Fatigue After Treating Thyroid Cancer

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Posted on Tue, 10 Feb 2015
Question: I had a total thyroiectomy 8 yrs ago and have been taking thyroxine since. I had thyroid cancer and since having them removed I cannot get my normal health back. I'm always extremely tired and my doctor and specialist keep changing my dose I have been on 50 micro mil to 75 micro mil to 100 to 150 back to 50 back to 100 which I am on now. They want me back on 50 as they say 100 is too high for me as a dose but on 50 I can never stay awake I just sleep all the time even on 100 I am always extremely tired but when I was on 125 I felt a lot better than I do on 100. But my doctors refuse to put my dose up that high. I have gained 12 kilos in 4 months even though my diet has not changed a bit. What can I do to feel better and have the energy I had before my thyroids were removed please help. Deslee
doctor
Answered by Dr. Shehzad Topiwala (2 hours later)
Brief Answer:
Thyroid

Detailed Answer:
Sorry to learn about your challenges with thyroid dosing.

It is usually not difficult to regulate thyroxine doses, especially for endocrinologists who are specially trained in thyroid management.

Once stable target levels of TSH and Free T4 are achieved, the thyroxine dose can be monitored infrequently, for example only annually.

When I see someone like you in my practice, I first determine if they can be presumed cured of the cancer. In order to go about this, firstly one needs to know what type of thyroid cancer you had. Then there is a systematic way to begin the assessment and a thorough physical examination is the first step. For example, in case of 'differentiated thyroid cancer', I typically order blood tests for serum quantitative thyroglobulin levels along with serum anti- thyroglobulin test.
If it is evident that the cancer is cured, then the goals for TSH and free T4 are set as for any other individual without a thyroid gland. I use 0.5 to 2 as a target range for TSH. I aim to keep Free T4 as close to the higher end of the normal range as possible.

With these objective in mind, I easily manage to keep my patients' thyroid doses stable in the long run.

Now every so often I do encounter individuals whose thyroid is not easy to stabilize. In these instances, I look for potential reasons:

1 Is thyroxine being taken correctly? Or is it being taken with food/other medications particularly iron and calcium?

2 Is it possible that the patient has celiac disease which can lower the absorption of thyroxine?

I see you are gaining weight but the key point is that if your thyroid blood tests are fine then other reasons for weight gain need to be explored.
There are certain rare conditions like acromegaly and Cushings disease which cause weight gain. You may wish to ask your endocrinologist if (s)he thinks you need to be tested for these.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shehzad Topiwala (13 hours later)
I have never seen an endocrinogogist ever no one has sent me to one
doctor
Answered by Dr. Shehzad Topiwala (2 hours later)
Brief Answer:
Follow up

Detailed Answer:
Well, it is about time you did
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shehzad Topiwala (5 hours later)
I was originally diagnosed with papillary thyroid cacinoma. After having bith thyroids rrmoved i had 8 day of radiotheraphy. I take 100 micro mil of thyroxine daily and 150 mil of exfelor for my depression. Does this help you figure out what thenproblem is Deslee
doctor
Answered by Dr. Shehzad Topiwala (1 hour later)
Brief Answer:
Second follow up

Detailed Answer:
I see.

Well in this case first ask your doctor if you are presumed cured of the cancer. This requires certain tests as explained above.

Once that issue is settled then aim for the TSH goals mentioned above for individuals without a thyroid gland.

It should not be particularly difficult to arrive at the right dose of thyroid medication for you. It is a matter of doing it with finesse and expertise. An endocrinologist is well trained to do this
Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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Suggest Treatment For Extreme Fatigue After Treating Thyroid Cancer

Brief Answer: Thyroid Detailed Answer: Sorry to learn about your challenges with thyroid dosing. It is usually not difficult to regulate thyroxine doses, especially for endocrinologists who are specially trained in thyroid management. Once stable target levels of TSH and Free T4 are achieved, the thyroxine dose can be monitored infrequently, for example only annually. When I see someone like you in my practice, I first determine if they can be presumed cured of the cancer. In order to go about this, firstly one needs to know what type of thyroid cancer you had. Then there is a systematic way to begin the assessment and a thorough physical examination is the first step. For example, in case of 'differentiated thyroid cancer', I typically order blood tests for serum quantitative thyroglobulin levels along with serum anti- thyroglobulin test. If it is evident that the cancer is cured, then the goals for TSH and free T4 are set as for any other individual without a thyroid gland. I use 0.5 to 2 as a target range for TSH. I aim to keep Free T4 as close to the higher end of the normal range as possible. With these objective in mind, I easily manage to keep my patients' thyroid doses stable in the long run. Now every so often I do encounter individuals whose thyroid is not easy to stabilize. In these instances, I look for potential reasons: 1 Is thyroxine being taken correctly? Or is it being taken with food/other medications particularly iron and calcium? 2 Is it possible that the patient has celiac disease which can lower the absorption of thyroxine? I see you are gaining weight but the key point is that if your thyroid blood tests are fine then other reasons for weight gain need to be explored. There are certain rare conditions like acromegaly and Cushings disease which cause weight gain. You may wish to ask your endocrinologist if (s)he thinks you need to be tested for these.