Hyperthyroidism - overactive thyroid gland
About 8 years ago ....
- my hands were shaking but I didn't tell hubby because I felt there's no big problem brewing
- I sweated for many nights, the back of my shirt would be totally wet ... what was I doing, merely sat down to watch television programmes with the fan switched on ... didn't do any exercises
- my heart pounded faster, thought was due to my irregular heartbeat which was found during my teen days
- weight loss ... was very happy about it so no need to raise an alarm
- one unlucky day, I was scalded by hot water because the handle broke, the pot of boiling water fell and some water splashed onto my body and thigh. I was trembling and in pain when I walked over to polyclinic.... pushing my special needs daughter out with me (was a homemaker). Thought the tremors were due to a 'boiling' horrific experience.
Hyperthyroidism is a condition in which your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism significantly. Simply put, hormones are released to carry messages to and from different parts of the body. Different glands produce different hormones. The thyroid produces specific hormones to direct cells to produce proteins and to burn energy. The adrenal glands produce hormones to help regulate stress and how we respond to it. Both of these glands work to protect our endocrine system, or our larger hormone-producing mechanism. The adrenal and thyroid glands work together responding to our body’s continually-changing conditions, and relaying information between the brain and the body.
The way these glands are signaled to release their hormones begins in the hypothalamus, an area of the brain that sends hormonal messages to the pituitary gland. This gland sends messages to the adrenal and thyroid glands, which then produce specific hormones, and send that feedback to the brain. This is referred to as a negative-feedback loop called the hypothalamic–pituitary–thyroid–adrenal axis (HPTA). For the thyroid to function optimally, it needs the right amount of stress hormone, or cortisol.
Signs and symptoms of an overactive thyroid include:
- Sudden, unexplained weight loss
- Increased sensitivity to heat
- Increased heart rate
- Nervousness, anxiety and irritability
- Hand tremors
- Changes in menstrual patterns
- Diarrhoea
- Bulging eyes
- Enlarged thyroid gland (goiter) that can appear as a swelling at the base of the neck
- Fatigue, muscle weakness
- Restlessness and insomnia
Hyperthyroidism can lead to a number of complications such as:
- Irregular heartbeat. This can worsen heart problems such as angina.
- Brittle bones (osteoporosis). Excessive thyroid hormones can affect your body's absorption of calcium into the bones.
- Eye problems. Grave's disease can cause protrusion of the eyes as well as sensitivity to light and blurring or double vision.
- Thyrotoxic crisis. The sudden intensification of hyperthyroidism symptoms, leading to fever, rapid pulse and even delirium.
Thyroid storm is triggered by a physically stressful event, such as an infection, heart attack, childbirth, diabetes or even hyperthyroid treatments like surgery and radioactive iodine therapy.
Stress seems to be a factor that's linked to the complications of many health conditions, including thyroid problems but that link is often difficult to define and even harder to prove. Other causes:
- Family history
- excess iodine, a key ingredient in T4 and T
- Smoking (particularly for thyroid-associated ophthalmopathy)
- Trauma to the thyroid gland (including surgery)
- Trauma eg Childbirth, Accident
- Highly active antiretroviral therapy (HAART)
- thyroiditis, or inflammation of the thyroid, which causes T4 and T3 to leak out of the gland
- tumors of the ovaries or testes
- benign tumors of the thyroid or pituitary gland
- large amounts of tetraiodothyronine taken through dietary supplements or medication
Both hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) are typically started by an autoimmune reaction. While Graves’ disease commonly causes hyperthyroidism, Hashimoto’s commonly causes hypothyroidism. Both disease processes are started by the body attacking the thyroid gland. It’s not entirely clear why men have less autoimmune disease than women. Researchers suspect it has to do with the differences in the immune system. Women have been found to have a more intense immune response to vaccinations, trauma, and infections, compared to men. So it is likely that this highly active immune system puts women at risk for more thyroid disease.
Antithyroid medicines like carbimazole are used to treat hyperthyroidism, which is also known as thyrotoxicosis. When your thyroid gland produces too much thyroid hormone, it can cause many of your body's functions to speed up, and this leads to symptoms such as losing weight, sweating, feeling irritable or shaky, and diarrhoea. Carbimazole works by reducing the amount of thyroid hormones which your thyroid gland makes.
Carbimazole is also a treatment used to prepare a person for thyroidectomy (surgical removal of part or all of the thyroid gland), and before radio-iodine treatment. From my sister's experience, the likelihood of having a surgery is high. Many risks involved so hubby and colleagues suggested I try something not too overwhelming eg herbs/TCM or essential oil.
Bone marrow depression including neutropenia, eosinophilia, leucopenia and agranulocytosis has been reported. Fatalities with carbimazole-induced agranulocytosis have been reported. Immune system disorders, eg Angioedema and multi-system hypersensitivity reactions such as cutaneous vasculitis, liver, lung and renal effects occur.
Remission is usually achieved at 18-24 months, after which attempts may be made to stop anti-thyroid drugs. Most patients with hyperthyroid Graves' disease are rendered euthyroid (having a normally functioning thyroid gland) by 4-8 weeks of treatment with carbimazole (20-40 mg daily). Once the patient is euthyroid, the dose of carbimazole is reduced until the patient is on the lowest amount necessary to maintain the T4 and T3 within the normal range.
Common carbimazole side-effects:
- Feeling sick, stomach upset - avoid rich or spicy meals
- Headache, muscle and joint pain
- Skin rash, itching
- Changes to the way things taste, hair loss
- reduces the numbers of blood cells which fight infection and help to stop bleeding.
Another said "all thyroid patients (hypo and hyper) should have their vitamin B12, Folate and Ferritin (iron store) levels checked regularly. I was diagnosed with Graves Disease last August and started taking 15mg of carbimazole. I am currently down to a dose of 5mg. I did go hypo which made me very ill, but with adjustments in my dosage my thyroid is all in the normal range now. However I was still experiencing a lot of symptoms and was sure it was my B12 which I had been treated for in 2006 but nothing since. My B12 was low normal, around 300, so every doctor I saw kept telling me I was fine. My Folate was very low. Luckily I have private medical cover and my Endo agreed to do an MMA test which was elevated indicating a diagnosis of B12 deficiency. I still don't know if I have classic Pernicious Anaemia, although probably yes as it is an autoimmune condition linked with Graves Disease and I tested positive for gastric parietal cell antibodies.
If you develop any of the following, let your doctor know straightaway:
- sore throat
- Mouth ulcers
- high temperature
- unusual bruising or bleeding.
- If you feel unusually tired or if you feel you are getting an infection.
Had been seen by polyclinic for many years and taken daily medication since the day I was diagnosed. I was off medication but hyperthyroidism came back based on my blood test result (TSH levels). Two years ago, I was off medication again.
July 2016, I started to have chest pain. The usual brisk walk (10 mins only) made me uncomfortable. Breathing deep made my chest tight, with bearable pain which didn't go away after two weeks. Heart pounded faster, hands not shaky but knees once awhile trembled so it didn't occur to me that hyperthyroidism was making a strong comeback.
I am now 'more hardworking' so I surf net and read a lot more than previous years. I printed out my treatment options, the symptoms, hyper vs hypothyroidism as well as the risks .... so Myanmar Dr felt I'm "knowledgeable". Many sources, including doctor said it is safer to be hypo than hyper. In spite of patients being more knowledgeable, with the free flow of information and correspondingly higher expectations, we are never in full knowledge of everything when interacting with doctors. Doctors assumed we should know, didn't ask details means we know or not of importance. I believe many patients & families don't know what are the right questions to ask, the actual impact and then get the most info out of the doctors mouth. In my case, the RAI treatment info is vague, Dr isn't doing the "extra mile"... something I felt he should know to let me plan and find out more about my insurance coverage/entitlement.
Doctors ought to inform patients what to expect at different stages of treatment, from the cost of diagnostics and procedures to the cost of a hospital stay. To me, this is basic knowledge. If there are additional charges owing to complications, the patient and his family must be updated at the earliest opportune time. When an estimate of the total bill is satisfactorily communicated from the outset, and agreed upon by the patient, complaints of overcharging may not arise in the first place. This reduces the risk of patient spending more than their insurance coverage. Healthcare costs are high even though you're a subsidized patient. How are we to know which are claimable, 100% or partial if Doctor isn't clear so insurance company representative doesn't have enough info to advise?
I've asked the Myanmar Dr to check whether I've excessive iodine but he said impossible and no blood test required. I said have have taken supplements: Spirulina 1000mg and multivitamins with 150mcg iodine. My triglyceride level wasn't asked to be tested. It is similar to low cholesterol, low triglycerides can be a sign of an elevated metabolic rate. Hyperthyroidism can also cause bones to become weak and thin, which can lead to osteoporosis. Taking vitamin D and calcium supplements during and after treatment can help strengthen bones... but Dr didn't say anything. In my earlier encounters (previously), I wasn't advised to take calcium supplements.
FYI, if hyperthyroidism has already recurred before, then the chance of another recurrence may be more than 90 per cent. This is because TSH receptor antibodies (TRAb) tend to persist in your bloodstream, and continuously stimulate the thyroid gland to be hyperactive. Long term poorly controlled hyperthyroidism can cause serious damage to the heart and bones.
As per web search, untreated hyperthyroidism can lead to serious complications, mainly related to the heart. When you have hyperthyroidism, your body is, in a way, running on overdrive all the time, and that can greatly affect your heart. Some possible heart-related complications of uncontrolled hyperthyroidism are:
- Arrhythmia (abnormal heart beat, such as atrial fibrillation)
- Cardiac dilation (increase in the size of the heart cavities, which actually thins the heart muscle) and congestive heart failure
- Sudden cardiac arrest
- Hypertension
- If you don't treat hyperthyroidism, you also run the risk of developing osteoporosis. You can gradually lose bone mineral density because uncontrolled hyperthyroidism can cause your body to pull calcium and phosphate out of the bones and to excrete too much calcium and phosphorous (through the urine and stool). You need calcium and phosphorous to maintain healthy bones, so if your bones aren't absorbing enough those minerals or losing them at an increased rate, they can become less dense. This can also make your body temporarily hungrier for calcium after thyroid surgery. Eventually, you may develop osteoporosis—meaning that your bones aren't as strong as they should be and making you prone to fractures.
I'm worried this time because I have chest pain. I stopped doing exercises, not something strenuous... just enough to let me sweat away as well as detox. This is to avoid my heart beating too fast - heart working too hard could cause me to be aimed by "silent killers". When I talk, I speak very fast and in nervous tone.... as if I'm having stage fright.
Treatment options for hyperthyroidism depend on your age, physical condition, and the cause and severity of your condition. These include:
Anti-thyroid medicine - Cabimazole
These drugs gradually reduce the symptoms of hyperthyroidism by blocking the production of thyroid hormones. Symptoms usually improve within 6-12 weeks of taking the medication, and this may last for at least a year or longer.
Radioactive iodine treatment (RAI)
For those who don't respond to anti-thyroid medications, radioactive iodine is taken orally and absorbed by the thyroid. Symptoms usually subside within three to six months. This treatment causes thyroid activity to slow considerably and possibly permanently (hypothyroidism), and you may have to take thyroid supplements. The main problem with anti-thyroid drugs is that hyperthyroidism often comes back after they are stopped. This is why many patients with hyperthyroidism are advised to consider more permanent treatment for their condition.
Surgery (thyroidectomy)
Removing your thyroid gland as a last resort. Risks include damage to your vocal cords and parathyroid glands - the four tiny glands located on the back of your thyroid gland that help to control the level of calcium in your blood. You may need life-long treatment with medication (Synthroid) to keep your thyroid hormone level normal post-surgery. If the parathyroid glands are also removed, you'll need medication to keep your blood-calcium levels normal.
Thyroid surgery is an effective treatment for hyperthyroidism and is particularly recommended if the goitre is very big and cosmetically unattractive to you. It is also used if there is a concern about cancer in the thyroid, and in certain women considering pregnancy who do not want to be on anti-thyroid medication. Your thyroid hormone levels need to be normalized with anti-thyroid drugs first before this operation can be done. There is a risk of hypothyroidism if too much thyroid tissue is removed, while a small number of patients may remain hyperthyroid if insufficient tissue is removed. There will also be a scar on your neck but this usually becomes pale and unnoticeable after a while. Rarely, the parathyroid glands, which lie very close to the thyroid and control calcium levels in the blood, may be damaged. In this case, long term treatment with calcium and vitamin D tablets may be necessary. Uncommonly, the nerves supplying the voice box may be damaged during surgery, resulting in a hoarse voice.
The thyroid gland is situated in the neck and its hormones control the metabolic rate of tissues.
It is stimulated and controlled by TSH from the anterior pituitary. TSH is released by thyrotropin-releasing hormone (TRH) from the hypothalamus. The thyroid gland, in response to TSH, produces thyroxine (T4) and triiodothyronine (T3). Greater amounts of T4 are produced than T3.
T4 is inactive and needs to be converted to T3 - which occurs peripherally (such as in the liver and kidney). Most T3 and T4 in the circulation are bound to protein (mostly thyroglobulin); it is only free thyroid hormone that is active. Free thyroid hormones in the circulation act negatively on the hypothalamus and pituitary - thus reducing the release of TRH and TSH.
I thought the specialist/endocrinologist would recommend that I go for surgery, was mentally prepared for an ugly cut. My lab result showed a high T4 thyroxine of 40, normal range 9-19. I have no goitre, thus, Dr said I can choose RAI. It means using radiation to destroy or damage my thyroid gland. Full damage would make patient become hypo and hormone tablet has to be taken for life.
Read online about the precautions to take for RAI and realised I need a place to be confined but Ng Teng Fong hospital doesn't have the required facility for patient to stay in. Dr said Spore General Hospital (SGH) has the facility but a web search lead to this "An elderly woman was given 1,000 times the correct amount of radioactive iodine after a doctor got confused over the dose. Instead of giving it in microcuries, doctor used millicuries, which are 1,000 times stronger."
Radioactive iodine therapy for hyperthyroidism has been used for more than 50 years. Former US president George Bush and his wife had radioactive iodine therapy for Graves’ disease. Colleague commented that after the media exposure of SGH's carelessness, their personnel will learn and become careful. Once bitten, twice shy, my risk is lower at SGH.
Asked doctor any other hospital that allows patient to be warded, Myanmar doctor was unsure. A doctor who can't tell me more about RAI made me uneasy. I certainly don't want my kid to be exposed to radiation. Other patient who did RAI roam around in public areas and/or take public transport? What happen to those who don't have a spare room to be confined in order to stay away from children and pregnant women? Made me felt I'm the only patient who wants to know how RAI is treated and managed in hospital... expected Dr to know the answer yet doctor unprepared for such simple question.
An Endocrinologist and a Surgeon handle different areas. You must speak to the right person by putting in extra money and time? An Endocrinologist can't answer 'simple questions' related to RAI or surgery.... what's the point of being so specialised, 'work' is divided, no one person in-charge to provide better service and take care of patient? Why we need to go thru so many channels? Felt like changing a specialist .... will be going to polyclinic and see whether it can give a better referral. Don't want to waste my time going back to a endocrinologist that leaves me with question marks. Myanmar Dr wanted to give me 6 tablets (30mg) per day, triple of what I was prescribed when discharged from A&E 2 weeks ago. Said I haven't taken such high dosage. Reduced dosage is 4 tablets (20mg) for first 4 weeks, then 2 tabs (10mg) the next 4 weeks. On that consultation day, I had to take blood test to ensure my liver could handle cabimazole. Also to check that my white blood cells are in normal range.
Radioactive Iodine Ablation - RAI can destroy all or part of your thyroid. While there are instances when you don't need to destroy the entire gland to alleviate your hyperthyroid symptoms, the total destruction of the thyroid is most often necessary. Depending on the dose, radioactive iodine can kill a portion, or all of your thyroid. Your doctor will order a radioactive iodine uptake and scan to determine your dose (I didn't get this test), the cause of your hyperthyroidism, and information about your thyroid tissue. In this test, you will ingest a very small dose of radioactive iodine. Your doctor will observe your thyroid's activity level by measuring the amount of iodine it absorbs. He or she will do this using a scan of your thyroid, which will show the healthy and diseased tissues.
In determining the best dose, the size of the thyroid gland (determined by a physical exam) and results of the uptake test are the two most important factors. The larger the gland, the larger the radioactive iodine dose. The higher the iodine uptake, the smaller the dose.
SGH's practice - Keep your stomach empty two hours before the treatment. Stop all anti-thyroid drugs, cough mixtures, multi-vitamins and traditional herbal medicine three days before till three days after the treatment. Stop L-thyroxine (thyroid medication) for four weeks before the treatment. The radio-iodine is a colourless and tasteless liquid, just like water. It is kept in a small plastic tube in a lead container. You will be told to drink the radio-iodine using a short straw. Be sure to drink every drop to ensure accuracy of the dosage given. After you have drunk the radio-iodine, some water will be added to the tube and you are to drink the water as well.
Radioactive iodine only affects your thyroid gland. Thyroid cells are the main cells in the body that can absorb iodine, so there is very little radiation exposure to the rest of your body's cells. When the thyroid cells absorb the radiation, they are damaged or destroyed. Approximately 90% of patients need only one dose before they are cured of their hyperthyroidism. Though you may only need a single dose, it may take up to six months before the medication fully destroys all or part of the thyroid. Fortunately, most patients experience reduced symptoms about a month after treatment. If your symptoms persist 6 months after treatment, you may need a second dose. In the rarest of cases, some patients will not benefit from a second dose and may instead require surgery.
The most common side effect of radioactive iodine may seem ironic, yet it makes perfect sense—hypothyroidism. The radioactive iodine often kills an excessive amount of thyroid cells, leaving the thyroid unable to produce enough hormones—the opposite problem you had before. It might seem odd to replace one disorder with another, but hypothyroidism is much easier to treat on a long-term basis than hyperthyroidism. If you develop hypothyroidism, you will need to take life-long thyroid hormone replacement therapy but it is a safe, reliable, and cost-effective treatment.
Sometimes, if you have Graves’ disease and your eyes are seriously affected by the disease, RAI may cause a worsening of your eyes. In these cases, your physician may give you a form of medication called steroids to take after the RAI to protect you from worsening eye disease. Some physicians may discuss alternative treatment and avoid RAI completely.
Other side effects of radioactive iodine include:
- Metallic taste in the mouth: This can last for a few weeks.
- Nausea: This usually subsides one to two days after treatment.
- Swollen salivary glands: This can last for a few weeks. It is caused by iodine absorbed by the salivary glands, though stimulating saliva flow a day after treatment (by sucking a lemon drop, for instance) is an effective remedy.
After RAI Treatment - In the days following radioactive iodine therapy, you will need to take certain precautions to prevent radiation exposure to others. Keep in mind that the precautions listed below are general, and your doctor will be more specific about how many days and what kinds of precautions you need to follow tailored to your individual needs and medical circumstances.
- You should sleep alone for 3 to 5 nights after treatment, depending on the strength of your dose.
- Personal contact with children (hugging or kissing, for example), should be avoided for 3 to 7 days, depending on the strength of your dose.
- For the first 3 days after treatment, stay a safe distance away from others (6 feet is enough). Avoid public places and drink plenty of water (to encourage the removal of radioactive iodine through your urine).
- For the first three days, do not share items (utensils, bedding, towels, and personal items) with anyone else. Do your laundry and dishwashing separately. Wipe the toilet seat after each use. Wash your hands often, and shower daily.
In SGH - Thyroid Cancer Treatment
The procedure and patient preparation are the same as for thyrotoxicosis. The only difference is that you will be given a much higher dosage of radio-iodine. This will enable the thyroid cells to be killed. You will have to be hospitalised for up to four days for this treatment. This is because your body wastes will be radioactive and they have to be stored in special holding tanks where they are allowed to remain until they are less radioactive before they are flushed into the normal sewers.
I have muscle ache and my knees are like having arthritis. Read online, hyperthyroidism mimic many medical cases. I thought I was having early menopause because many symptoms fit but turned out to be hyperthyroidism/Graves disease. I prepared a checklist for the polyclinic doctor to see but she strongly said can't be because the most important symptom, menstruation stop in woman didn't happen to me.
Currently, I have no obvious weight loss ... so disappointed. I could still fit into my skirts.... probably putting on weight instead (hypo symptom) because due to high metobolism, I felt hungry easily so I'm eating much more. 不是少量多餐.....惨了!
My youngest sis read my company hospitalization and surgery policy, said pre-existing not covered .... so I must pay the bill fully? Spoke to HR, was directed to insurance company. I need to know whether I'm covered, how many percent out-of-own-pocket, etc. Raised these questions, stated I'm a subsidised patient yet Agent asked "Do you have any estimate hospital bill size that you can forward to us for us to assess?" From the way he emailed, looked like cost is the subject so I replied "what's the cap for RAI" so that I can keep within budget.
Wish more people could share. Google but didn't find any useful info about receiving RAI in hospital. Hope this blog can help some people who are clueless and frustrated like me.
How to break the stress-thyroid connection
* Nourish yourself. Eat three well-balanced and two healthy snacks each day that include high-quality protein. Breakfast is especially important to help regulate blood sugar and hormone production. Reducing sugar and caffeine intake is important to help combat stress. Also, enjoying meals in a relaxed setting and eating slowly can help digestion and metabolization of important nutrients.
* Add vitamins and supplements. There are many important elements to healthy thyroid functioning. Iodine, Selenium, zinc, copper, iron, and vitamins A, B, C, and E all play crucial roles in the production and maintenance of thyroid hormones. High-quality multi-vitamin and mineral supplements can help support the necessary balance.
* Get enough sleep. Sleep is an amazing way to restore and rejuvenate our bodies and our minds. When we have the right amount of sleep, our bodies will regulate and reset our neuroendocrine system to help promote hormonal balance, and also help us face the next day’s challenges. Especially important is adequate downtime before bed, so that our adrenal glands slow down the stress response and rest as well.
*Relax. There are many ways to counter daily stress and help our bodies and minds relax. Options include deep breathing exercises, yoga, meditation, walking, or simple exercise. Too much exercise can actually stimulate our adrenal glands as opposed to relaxing them, so moderation is key. Be sure you find a few methods you enjoy, so that you can commit to a daily relaxation regime.
Think about therapy. Making emotional changes can be very difficult. Sometimes we are so entrenched in certain negative patterns that we not only cannot get out of them ourselves, but also may not even recognize it. Exploring both positive and negative patterns in our lives can help us break the stress responses that over time can lead to physical distress and disorders.
Oct 2016
Instead of going back to Ng Teng Fong hospital, to get a referral to SGH I decided to go to polyclinic.... much cheaper and nearer to me. I was charged a new patient fee of S$92 (before subsidy) to see the Endocrine Dr. The T4 test cost $101.90 before subsidy so my first visit, I paid $93.55 in total after subsidy. Endocrine Dr referred me to the Nuclear Dr after seeing my blood test report was normal. It was a subsequent SGH visit so I paid $37.
Searched internet, rang hospitals hoping to be warded for the initial first two days of RAI treatment. No hospital in Spore allowed it. At SGH, no matter how much I explained, highlighted my worries, the need to be away from my girl, the clinic nurse, Nuclear Dr and his senior said for low dosage, there's no need and no facility to accommodate my request. It is not a standard practice to admit low dosage RAI patient in Spore. I was given this paper:
Nuclear Dr said it is perfectly alright to take public transport as long as I don't sit next to or be close to babies and pregnant women for more than 30 mins. How would I know a woman (in first trimester) is pregnant? Her tummy isn't showing so how do I know who is safe and unsafe to be near? Due to this irresponsible practice, there could be possibilities that a RAI patient was near me when I was pregnant, thus, the radiation caused me to have a special needs child? It is hard for me to be 1 meter away from my girl or any "pregnant woman". Many people hesitated to give up priority seats in mrt because some pregnancies are not obvious. One friend who worked in healthcare line checked for me and was told some RAI patients .... for the sake of young children (below 5 years old) and be "social responsible", decided to book a hotel till the radiation wear off. All these are not reimbursable. No insurance company or company welfare won't take in your "hotel" claim.
Taking a taxi (small confined area) is still considered "unsafe" in my opinion because you won't know immediately after you, did a pregnant woman get into that taxi. Don't understand why some people didn't think far and play safe for the benefit of others. You may want to say the possibilities are extremely low .... but it can occur to an unlucky person, especially when the RAI patient happened to cough or sneeze.
You can't blame the RAI patient because Dr ....a person deemed to be very professional assured it was ok and ignored the unforeseen circumstances. Egoistic doctors just felt patients have over worried, they hate patients who are not submissive. Met egoistic KKH doctors before my girl was diagnosed, a mother's instinct was brushed aside, my observations to them were unfound. My girl visited KKH once a month when she was three months old. I noted she was abnormal but KKH pediatrics brushed aside. During the routine child development visit at polyclinic, I raised my points, the nurse did some checking and agreed I wasn't making a mountain out of a molehill. With that report, KKH finally decided to take actions by running lab tests.
As you can see from pic, my RAI treatment is in Dec. Dr said I am fit to resume work the next day. He and his senior felt I have over reacted. I don't want to be finger pointed for any "mishaps/unfortunate things" so I don't intend to tell my colleagues I'm going for RAI treatment.
If I knew SGH is so strict and irresponsible then I won't waste time, money and effort to go. I would have sticked to NTF because it is nearer to my house and save on the "first visit cost". FYI, getting T4 done in polyclinic is many times cheaper.
Did a TSH blood test after receiving RAI, the cost for a subsidized patient was $50.95. Non subsidized rate would be $101.90.
May 2017
Received RAI treatment in Dec 2016. I read a lot on these and was aware that the liquid I had was a form of radiation. I didn't want to cause any harm to the public, especially pregnant women. Maybe my teen was caused by some "unwell" patients who aren't aware that they had played a part "by spreading unwanted love".
Maybe somebody sat next to pregnant me in the train for more than 30 mins?
Maybe a colleague was hanging around too close to me when I was pregnant?
Maybe the taxi I took was taken by a RAI patient?
No matter how many maybes there are, Spore medical guideline didn't feel that there's a need for RAI "low risk" patients to stay away or don't share public transport/area on the initial two days.
I was referred to Ng Teng Fong General Hospital because this is the closest place to have RAI treatment. The doctor said RAI treatment is not a warded case, low risk patients cannot be warded till the radiation wears off (I was hoping for 2-3 days MC without asking). I went to polyclinic and had another referral to SGH. Was told SGH is the only hospital in Spore to have warded radio-iodine patients.
Again, my request to be warded was rejected. I wanted to be at least 3 days away from my girl or the public but SGH doctor said the dosage given was low so I was told I could go back to work the next day. Medical leave was only on the day of treatment. If I felt I had to be away from my girl or carry out social responsibility (eg not taking public transport home and spread "unwanted love" on my way home), was recommended to stay in somebody else's house or a hotel (not eligible for any medical insurance reimbursement). Maybe I looked angry that I wasn't "confined", the doctor (after taking the liquid) decided to amend the medical leave from 1 day to 3 days. It wasn't a hospitalization leave, just MC!
Doctor and clinic nurse said the dosage given was extremely low. I felt like it was a droplet when I tried to suck from the straw. The standard guideline stated I shouldn't share things, should use disposables - easier to throw. After visited the toilet, I had to flush twice ... for the benefit of the next user, who might be a child or pregnant woman.
Doctor said if I insisted to be warded, a higher dosage has to be given. Also, I'm likely to suffer because the patients warded are receiving much higher dosage.
After treatment, I felt normal. The only difference I felt was my throat was tender. Felt slight pain when I stroked it the next few days. Then, I discovered I get sore throat easily. After two months, I noticed just eating two small pieces of chocolate or one biscuit would land me with a bad sore throat.
When I'm updating this four months later. My throat is much better but prone to sore throat. Haven't visit the polyclinic for blood test. After RAI, I was given thyroid replacement hormone.... I'm now a hypo instead of hyper. Hypo is safer than being a hyper because the medicine, an anti-thyroid drug (Carbimazole) may develop severe side effects such as liver inflammation or a deficiency of white blood cells. I have been taking Carbimazole on and off for 3 cycles, total about ten years.
Thyroid replacement hormones are medications used to treat hypothyroidism, a condition in which the production of thyroid hormone in the body is abnormally low. Thyroid hormones increase cellular metabolism (activity of cells) that is responsible for growth, development of tissues, maintenance of brain function, body temperature regulation and several other cellular processes. Low levels of thyroid hormones in the body can result in many problems given the numerous activities that they mediate.
Note: All costs related to RAI, consultations aren't claimable thru insurance because patient is not hospitalized. If you've staff medical benefits, you can claim from your company, as part of your yearly staff entitlement.
Jun 2017
Did a TSH blood test on my first follow-up visit to polyclinic, the cost for TSH lab test rose from around $10 till now, $33.10. Still cheaper then making a trip to SGH.
I am required to take one hormone 75 mcg replacement pill at least 2 hours before food. No increase or decrease of dosage since I was discharged from SGH, Feb 2017. Milk products and calcium consumption should be taken after 2 hours of having my hormone pill.
Noticed the initial few months after taking the hormone pill, I had stronger menstruation flow. This month, I started to 'revert back to normal light menses'.
My neck is no longer sore when I stroked it, felt ok about 2 months later. The tendency of developing sore thorat is still high by taking just 3 pieces of biscuits.
3 months later, I will need to go to polyclinic for blood test - monitor my level.
Reference:
Blog of another blogger for your comparison
Thyroid discussion
New thyroid operation leaves no visible scars - Straits Times, 28 Apr 2017
As a significant number of those diagnosed with thyroid lumps are young women, patients are often anxious about scarring after surgery, said Dr Jeremy Ng, head and senior consultant at the Department of General Surgery at SGH.
But this scar-free procedure, known as transoral endoscopic thyroidectomy, is the least invasive among existing types of thyroid surgery here. Instead of operating through the neck, chest or armpit, as in other types of thyroid surgery, the surgeon goes through the patient's inner lower lip, which hides any wounds. The entire procedure takes two to three hours. Patients tend to stay in hospital for two to three days.
Even though conventional thyroid surgery takes less time, lasting one to two hours, and has a low complication rate, it can leave a visible scar across the neck. Other surgical options leave scars on the chest or armpit, and could cost as much as $10,000. The transoral method costs about $2,000, after subsidies, for a patient in a Class B2 ward - similar to the costs for conventional surgery.
Nov 2018
I'm still taking my Euthyrox (Levothyroxine sodiun) 75mcg hormone replacement pill (since Dec 2016). Last week, had my regular TSH test and was told my level seemed low, was asked whether I've been taken my pill daily. I don't recall missing a tablet so Dr gave me a 4 months lab test appointment instead of 6 months. Said it wasn't necessary to re-do a lab test so soon.
I'm glad my hyper thyroid wasn't the kind that required surgery. RAI was a right choice for me.
Lifestyle and health - no change
Sleeping - still a light sleeper
Weight - putting on weight but I think it is partly due to hypo, "my old age" and hardly do any exercises
Cold intolerance - I need a shawl when I'm in air-con places, seems like my shoulders have really low cold tolerance
Thank you so much for writing this. I had my RAI consulate on with SGH Nuclear medicine Dept. Few years ago and I was so put-off by the Doc. I met on that day that I decided not to go-ahead with the RAI when some simple questions can't be addressed in a professional way. Was re-considering RAI option again this year and researching info from net.Happened to come across your post. Appreciate your informative and first-hand write up.
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