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As of 1 November 2008, there are two Levothyroxine medications on the Pharmaceutical Register, meaning they are funded by Pharmac. Eltroxin by GlaxoSmithKline, and Goldshield's version, commonly known as Goldshield.

Also available at some pharmacies are other options, Synthroid, Almus, Teva. These versions are not funded and will cost you. It pays to check with pharmacies before submitting your prescription, as they may not stock the particular variety you prefer.

Prescribing Information for Goldshield.

Adults up to 50yrs - take 50-100 a day. May adjust by 50 every 4-6 weeks.

Adults over 50yrs - initially up to 50mcg a day. Adjust according to clinical response.

Cardiac Disease - initially 25 a day. May increase by 25 every 2-4 weeks.

As Goldshield does not have the right to use the name Eltroxin in New Zealand, their medication is being marketed under the name Levothyroxine. The current batch has packaging that does not mention Goldshield as the manufacturer. Instead, the product licence holder is Forley Generics Ltd which is a wholly owned subsidiary of Goldshield Pharmaceuticals Ltd. Further batches (due around March 2009) will be available in New Zealand-approved packaging with Goldshield Healthcare (NZ) as the sponsor. To make sure you are actually receiving the Goldshield Levo, they should come in blister packs in a box. The box artwork can be seen here. Some people have been given Eltroxin in a bottle labelled Levothyroxine! This is not legal. If your prescription states Goldshield levo, you should receive it in blisterpacks not bottles. Aother illegal practice we are hearing about... making patients take a bottle of 1000 pills (you can demand only what you need for a month at a time),

The medsafe data sheet for Goldshield can be read here.

It is recommended that when you go onto an alternative levothyroxine, you start with a reduced dose of 50% (half) your usual dose of Eltroxin.
Dosing Regime:
1/2 normal dose for 10 days
3/4 normal dose for 10 days
full dose for 10 days
then request a new set of blood tests from your doctor. There is a possibility that you may not need as high a dose as on the Eltroxin.

4 Dec '08 - We are receiving reports of Pharmacies running out of Synthroid & Goldshield. Some folk have actually been told there is no more!! This is not true. However, there does appear to be a shortage in the North Island. Goldshield based thier supplies on information from Pharmac. Pharmac have obviously well underestimated the number of patients who were likely to switch from Eltroxin. Healthcare Logistics are the suppliers of Synthroid and Goldshield (as a subsidised medicine) should be stocked by every wholesaler. If your regular pharmacy is not keeping their stocks up, you can move your prescription to another pharmacy. The Pharmacy holding the original prescription makes a "certified true copy" which they keep for their dispensed portion of the prescription and annotates the original to say what has been dispensed, and gives it back to the patient. If your pharmacist tells you it is not possible, tell them to check with HealthPAC.
Update Emergency supplies will be delivered to wholesalers by Friday. All wholesalers' back-orders will be completely filled by the following Friday. Those areas that run out for whatever reason i.e. panic prescription filling, can phone 0800 565 633 , and they will receive an emergency supply within 2 days. They (Abdul Azam) cannot apologise enough to all thyrodians of NZ. The demand to change to Goldshield (Forleys) has exceeded expectations.

Update Feb. '09 - It has been reported that the demand for the alternative levo has been closer to 50% of all levo users, not the 20% first estimated. Many professionals/govt officials thought the symptoms were ‘pyschosomatic’…. It seems the patients are saying something different

http://www.medsafe.govt.nz/profs/PUArticles/Eltroxin-Feb09.htm
"Four brands of levothyroxine now have Ministerial consent for distribution in New Zealand. These brands are Eltroxin (GlaxoSmithKline), Synthroid (Abbott), Goldshield Levothyroxine, and Eutroxsig (Sigma). The Eltroxin and Goldshield Levothyroxine brands are fully subsidised by PHARMAC."

Update 30 June 2009 - Notification has been received today, that Synthroid will be funded as of 1 August, 2009.

Thank you to Allan & Helen Campbell for the some of the information on this page.

For over 100 years dessicated pig’s gland was used successfully as the treatment for Hypothyroidism. In the 1970’s it was usurped by synthetic T4-only medications and doctors ceased to be trained in it's use.
Whole Thyroid (Thyroid USP) is standardised whole desiccated porcine gland which contains a combination of thyroid hormones and their precursors i.e. Thyroxine (T4), Triiodothyronine (T3), Diiodothyronine (T2), and Monoiodothyronine (T1) as well as calcitonin and any other hormones usually present in the thyroid.
Desiccated thyroid extract can be used by itself, as a complete thyroid hormone replacement treatment or in combination with synthetic T4 or T3 to alter the ratio of T4 to T3. The ratio of T3 to T4 is fixed at approximately 1:4, so it can't be adjusted unless T4-only or T3-only pills are taken as well.

Although Thyroxine (T4) is still the standard treatment for hypothyroidism, many studies had proven that the combination of T3 & T4 is a much better way of addressing hypothyroidism. Thyroxine (T4) is a prohormone for triiodothyronine (T3) as it is converted to the active T3. T3 is the dominant hormone in all body cells. It exerts the thyroid function in the different body organs with the predominant action on the brain, enhances long term memory and reduces anxiety. Patients on the combination therapy have reported that it improves the feeling of well being. In addition, this therapy has been shown to improve mood and alleviate depression. In contrast, research shows that treatment with T4 alone does not improve cognition and psychological wellbeing. T3 may also improve memory and help weight loss. Studies are underway into the functions of T2 & T1.

Currently in New Zealand there is no consented medicine containing Whole Thyroid.
This medication can be compounded on prescription and supplied in accordance with Section 29 of the Medicines Act and Regulation 44 of the Medicines Regulations.

APPROX. CONVERSION GUIDE:

Standard [USA]	Whole Thyroid	Synthetic Thyroxine
1/4 grain	16.25 mg Thyroid USP	25 mcg Levothyroxine [T4]
1/2 grain	32.5 mg Thyroid USP	50 mcg Levothyroxine [T4]
1 grain	65 mg Thyroid USP	100 mcg Levothyroxine [T4]

Click here to read this on the web. ]]> Sun, 22 Feb 2009 03:09:22 GMT http://www.nzthyroid.comfypage.com/23.htm http://www.nzthyroid.comfypage.com/24.htm Laboratory tests for thyroid disorders need to be carried out to:

1. Check if your thyroid is working normally
2. Find any fault
3. Determine if the problem is mild or serious
4. To find the correct dosage of any medication
5. Monitor progress

However, no test is 100% accurate. Standard Thyroid Tests are:

FT4 - Free Thyroxine - NZ Reference Range 12.0 - 22 pmol/L
FT3 - Free triiodothyronine - NZ Reference Range 3.1 - 6.8 pmol/L
RT3 - Reverse T3
TSH - Thyroid-stimulating hormone – NZ Reference Range 0.27 - 4.2 mIU/L
TPO - Thyroperoxidase
Tgab - Thyroglobulin antibodies

T4 - measures the amount of T4 in the blood, both free and attached to proteins. If the reading is below 12 standard units, it suggests an underactive thyroid; if it is more than 22 standard units, this could mean an overactive thyroid, but other things may not be equal. A shortage of carrier protein will give a low result and an excess of protein will give a high result. Even so, the thyroid may be working correctly.

Increased protein and hence a high reading may be caused by many problems:

- Pregnancy, HRT (or contraceptive pill)
- Hepatitis
- Porphyria
- Cannabis
- hereditary

Reduced protein giving a low reading could be caused by:

- Steroids used in treatment
- Bodybuilding steroids
- Nephrosis
- Cirrhosis
- Heredity

To check if an abnormally high or low T4 level is due to the thyroid, there are a couple of choices - the TSH or the FT4 test.

TSH TEST
This is often used instead of, rather than as well as the T4 test. If the thyroid is not producing enough hormone for the body's requirements. TSH comes into action to make the thyroid increase production. If the TSH result is above the critical level (2 or more in either international or standard units), the thyroid is underactive.

FT4 TEST
Some medical practitioners believe that this is the true measure of thyroid activity - other practitioners do not believe this test should be used alone, without taking into account clinical examination and symptoms

T3, FT3 AND RT3 TESTS
A high FT3 level occurs in hyperthyroidism or Graves Disease. With a healthy thyroid, increasing age causes a slow reduction in T3, unlike T4 and a number of illnesses have the same effect - low T3 syndrome. Fasting, starvation and anorexia nervosa all induce a low T3 level with a corresponding increase in reverse-T3.

TPO and Tgab are tests for thyroid antibodies produced by the system itself, and above normal levels indicate autoimmune thyroiditis (Hashimoto's disease).

ANTIBODY TESTS
From a patients point of view, these are simple - just an ordinary blood test. For the laboratory, they are complex. Antibodies in the blood indicate susceptibility to autoimmune thyroid problems.

1. Graves' disease. The main responsible antibody is TRAb - thyroid receptor antibody. If there is a high level of this during pregnancy, it is a warning to take action to protect the unborn baby

2. Hasimoto's disease. Several antibodies are involved, including anti-Tg (antithyroglobulin) and anti-M (antimicrosomal). The majority of Hashimoto suffers carry these antibodies, but so do 1 in 5 people who have never had a thyroid problem. This last group may, however, be more susceptible to developing an autoimmune disorder if the thyroid is put under stress, by, for instance, lithium medication, an infection or a faulty diet.

24-HOUR URINE THYROID HORMONE TESTING
The 24-hour urine thyroid test serves as a valuable tool for detecting thyroid dysfunction that can go undetected through the usual standard blood tests. It is important to use this test in conjunction with other indicators of thyroid function, such as body temperature, symptoms and standard blood thyroid tests.

RADIOACTIVE UPTAKE (RAIU) TEST
This tests how effectively the thyroid cells are latching on to the iodine in the circulation, which is a necessary ingredient of thyroid hormones. The test starts with a scan of your basic level of radioactivity, with a sort of Geiger counter. They you are given a measured dose of a mildly radioactive form of iodine in a capsule or as a liquid. The thyroid area is then scanned again at various intervals up to 24 hours to see how much of the iodine has been taken up. For a quicker test the follow-up scan can be done three to four hours after the start, but in this case you must do without food during the whole time.

The results are useful in diagnosis and also ion assessing the dosage necessary if radioiodine treatment is in view.

High uptake will result from:

- Graves disease and other overactivity
- Iodine deficiency
- Having stopped antithyroid drugs
- A diet full of soy
- Kidney disease

Low uptake will result from:

- An underactive thyroid
- Medication containing iodine
- Diet - iodine-enriched foods or vitamins products
- Taking thyroxine - you must stop one month before the test
- Previous radioiodine treatment or thyroid operation
- Old age
- Having just exercised very energetically

The radioactive iodine used for the RAIU test has nothing like the strength of that used in treatment. Its radioactivity only lasts for ¾ days. Another radioactive material, technetium, is sometimes used instead of iodine; it is given by injection. Whichever material is used, the test is unsuitable for young children or anyone who might be pregnant, even at this low level of radiation.

SCINTIGRAM . This technique uses a special camera to produce a brightly multicoloured picture showing where iodine is taken up by thyroid tissue, and how vigorously. Like the RAIU test, it depends on having a measured amount of the weak radioiodine,123I, or technetium 99m first. In a few centres fluorescent scanning is available: this measures ordinary, non-radioactive iodine through something like an X-ray, and almost no radiation is involved. Also called photoscan, scintigraph, scintiscan.

This test is useful:

- To show the size and shape of the gland.
- To check for thyroid tissue behind the breastbone.
- To find out whether a lump in the tongue or neck is thyroid tissue that has gone off course during development.
- Most importantly, to provide information on a particular knob or lump of tissue in the thyroid.

- a 'hot' nodule (showing as red) is overactive, taking in a lot of iodine;
- a 'warm' nodule (showing as orangey-yellow) is normally active;
- a 'cold' nodule (showing as greenish) is not taking up iodine and may be a cyst or a tumour. This calls for further investigation, to exclude cancer.

X-RAY . An ordinary X-ray gives a shadowy idea of the size and position of the thyroid. In particular, a chest X-ray may reveal a shadow, behind the breastbone, which could be an extension of thyroid tissue. Ultrasound, a CY scan or a scintigram will be needed for more precise information.

BARIUM SWALLOW This is an X-ray taken while you are swallowing a barium drink that shows up on X-ray. It reveals any pressure on your gullet.

CT (COMPUTERISED TOMOGRAPHY) SCAN . This is an X-ray that presents what looks like pictures of slices through the next or other area.

ULTRASOUND. This is a simple painless method of obtaining a picture of an internal organ, including the thyroid. It produces an on-going picture by processing the echo of a high-frequency sound projected on to the organ. Apart from distinguishing a cyst from solid tissue, the ultrasound provides an ongoing image of the organs and structures in your neck. This is invaluable for guiding the needle when a biopsy of a particular part of the thyroid is required.

FINE NEEDLE ASPIRATION. This is a method of doing a biopsy to obtain a sample of tissue to examine under the microscope and identify precisely. The great value of FNA is for distinguishing between a commonplace nodule of normal thyroid tissue, a harmless cyst or benign growth and a cancer. This knowledge is a signpost to the best form of treatment.

METABOLIC RATE. Although the main work of the thyroid is controlling the rate at which the bodily processes use up the available nourishment, the metabolic rate is seldom tested. A raised basic metabolic rate goes with over-activity of the thyroid, and accounts for the person who eats enormously and stays thin. The opposite occurs with an under-active thyroid.

ELECTROCARDIOGRAPH. This electrical tracing of the heart's activity is the standard method of assessing how well the heart is working. It shows characteristic changes in overactive and underactive thyroid.

OPTHALMIC CURVE METER. This apparatus measures the degree of protrusion of the eye or eyes.

http://www.jklcompany.com/28031.html

JKL's "NORMAL2 LAB VALUES GUIDE

Clinical Chemistry, Toxicology, Seriology - reprinted from health Reference - 2001

Thyroid New Zealand. This google group was set up to support those with thyroid issues in New Zealand. You will need to request membership and give information about yourself.

Thyroid Chatter This group is NZ-based and for thyroid support and discussion. It is moderated and you need to register before posting.

Real Thyroid Help This is a website of forums based on being hypothyroid and related issues. Created by Deborah, and assisted with several intelligent moderators. You will need to register before you can post.

Natural Thyroid Hormone Users This yahoo group has been in existence since 2002, and focuses on the use of desiccated thyroid like Armour and other brands. You have to request membership and give information about yourself.

NTH Adrenals Group This NTH sister group focuses on adrenal fatigue. Run by Valerie, a thyroid/adrenal patient who is quite knowledgeable about adrenal fatigue You will need to request membership and give information about yourself.

International Hormone Society forums These forums address hypothyroid and adrenal issues

T3 Resistance/Reverse T3 group This group is for those with high Reverse T3,

Iodine group Run by a thyroid cancer patient who beat the cancer, this group focuses on the use of iodine for good health.

Thyroidless group For those without a thyroid, whether through RAI, surgical removal or other issues, this group is run by the vivacious Sam.

For Physicians and Medical Professionals Only This discussion group is for medical professionals to talk to each other about desiccated thyroid and adrenal fatigue treatment. Specifically limited to legally qualified and licensed practitioners of medicine, or other healthcare professionals. Not for patients.

Goitrogens are naturally-occurring substances that can interfere with function of the thyroid gland. Goitrogens get their name from the term "goiter," which means an enlargement of the thyroid gland. If the thyroid gland is having difficulty making thyroid hormone, it may enlarge as a way of trying to compensate for this inadequate hormone production. "Goitrogens," like circumstances that cause goiter, cause difficulty for the thyroid in making its hormone.
In people with normal thyroid function, goitrogens can induce hypothyroidism and goiter. In those with hypothyroidism, goitrogens can further depress thyroid function and stimulate the growth of the thyroid (goiter). In those with hyperthyroidism, goitrogens may suppress thyroid function. This may be a double edged sword if used as a treatment plan. Goitrogens interfere with the uptake of Iodine by the thyroid. Limiting thyroid output by Iodine restriction can cause the thyroid to increase in size (goiter) in an effort to filter more blood to get more Iodine. Then the larger gland has the potential to produce more thyroid hormone when iodine is introduced back into the diet.
A better approach could be to increase copper metabolism by supplementation of copper and the assisting nutrients. Once copper is replenished and copper metabolism is working properly, the body will tolerate iodine without increasing thyroid hormone production. Copper is also closely connected to Iron and Vitamin C intake. A fine balance of all minerals, vitamins, and lipids is needed to ensure a completely healthy.

Many goitrogens are generally members of the brassica family. These include:
Broccoli Cauliflower Brussel Sprouts Cabbage
Mustard Kale Turnips Rape seed (Canola Oil)
Other goitrogens include:
Soy Pine nuts Millet Peanuts

Brassica family vegetables not only inhibit thyroid production, they also inhibit cancer growth. We know that sulfur, copper, and iron work closely together and that excessive sulfur can deplete copper and/or iron. Generally anemia is the result of low iron and/or copper. Also, foods and drugs that cause anemia also reduce cancer growth, indicating that the brassica vegetables might reduce cancer by inducing anemia.
The primary pre-condition for the production of thyroid disease is the onset of anemia. Brassica vegetables, with their high sulfur content, may be foods which induce anemia and consequently thyroid disease.

Hyperthyroidism - Good and Bad

Food contains minerals which affect the thyroid. As the hyperthyroidism is corrected, the foods on the avoid list will be tolerated better.
Also, a list of the foods that bother you can be a great help in determining what nutrient deficiencies you have and need to correct.

FOODS TO AVOID
Dairy - Excessive calcium to magnesium ratio increases rapid heart rate and tremors.
Garlic - Excessive zinc depletes copper.
Iodine containing foods - Until copper is built up.
Licorice - May be a toxic to the adrenals and thereby interfere with the sodium/potassium pump.
Tinned foods, especially fish like tuna - bisphenol-A (an estrogen mimic) from varnish inside the can, increases heavy metal accumulation like mercury and cadmium which accumulate in fish and other sea foods.
Fruits, at least for a while - depletes copper
High carbohydrate diet- causes thyroid hormone increase to burn up excess calories.
Too many green leafy vegetables - high in cadmium
Rice - high in cadmium
Canola oil - interferes with normal thyroid functioning

SUPPLEMENTS TO AVOID

Zinc--depletes copper so you need to limit zinc until copper is built up.
Iron--depletes copper so you need to limit it at the beginning, but it's essential for making hemoglobin so try to slowly introduce it after a few weeks of copper supplementation.
Manganese--Assists iron metabolism and a known copper antagonist. Introduce again if you go hypo.
DHEA
Pregnenelone
Grape seed extract
Proanthrocyanadins--from grape seed or pine bark.
Ephedra--found in weight loss and energy supplements.
Tyrosine--the amino acid that is the basis of thyroxine.
Arginine --stimulates growth hormone production which seems to stimulate thyroid hormone production.
Ornithine--same as Arginine
Licorice--depletes MAO which breaks down thyroid hormones after use.
Colostrum--seems to significantly increase hyper symptoms and may induce a thyroid storm.

FOODS TO EAT
Beans Crab Lobster Nuts Shrimp

Synthroid

• Levothyroxine sodium
• acacia
• confectioner's sugar (contains corn starch)
• lactose monohydrate
• magnesium stearate
• povidone
• talc

GSK Original

• Levothyroxine sodium
• magnesium stearate
• lactose monohydrate
• maize starch
• acacia

GSK New

• Levothyroxine sodium
• magnesium stearate
• microcrystalline cellulose
• pre-gelatinized maize starch
• purified talc
• silicon dioxide (Colloidal anhydrous silica)

Almus -

• Levothyroxine
• lactose
• magnesium stearate
• maize starch
• stearic acid

Forleys GS -

• Levothyroxine
• sodium citrate
• lactose
• maize starch
• acacia powder
• magnesium stearate
• purified water

ELTROXIN (Goldshield) -

• Thyroxine Sodium BP
• Sodium Citrate
• Lactose
• Maize starch
• Powdered Acacia
• Magnesium Stearate
• Purified water

Whole Thyroid Extract (Naturethroid) -

• Porcine Thyroid Powder, U.S. Pharmacopeia
• Microcrystalline Cellulose
• Dicalcium Phosphate
• Sodium Starch Glycolate
• Magnesium Stearate
• Hydroxypropyl Methylcellulose
• Stearic Acid
• Carnauba Wax
• Polyethylene Glycol

THYROLAR or liotrix is not natural desiccated thyroid. It is synthetic T3 (L-triiodothyronine) and synthetic T4 (levothyroxine sodium) with a ratio of four parts T4 to one part T3. It contains no T2, T1 or calcitonin. The tablets need to be kept refrigerated.

INGREDIENT EXPLANATIONS:

Microcrystalline Cellulose synthetically derived fibre base (similar to plant-derived). It is typically used as a filler in tablets to provide volume and bulk.

Dicalcium Phosphate derived from a mined ore. It is typically used as a binder in tablets to hold all the ingredients during compression.

There has been a lot of information in the media regarding the swine flu, but not too much about its connection to Whole Thyroid Extract.. In New Zealand the active ingredient in the WTE we use is Nature-throid, manufactured by RLC Labs. The Chief Science Officer, Dai Jinn has made the following statement ...

"In my reading and discussion," he said, "the very last concern I had regarding H1N1 is any transmission within our food supply, which would include pork-based thyroid medication. Although the origin hasn't been confirmed as to the recent outbreak, we do know that this virus has been identified and the new strain is an amalgam. It is a virus, and the way viruses commonly spread is by airborne sources."

Concerning Nature-Throid and other pork-derived products, Dai was clear: "I think it is very important to acknowledge the fact that no cases have been reported from anyone having ingested any pork-based products in the history of this virus."
"Our current supply of porcine thyroid is from a supplier that has no known cases (origin) of swine flu." He added, "I also don't believe that the virus can survive the purification and desiccation process and be viable at the end 'product' stage. I do have concerns about a pandemic, but not due to the spread of the virus by oral consumption of pork-based food and thyroid products."

There is much information available on the internet, I have added some links below for your quick reference.

Official Statement from Nature-throid - http://www.thyroidscience.com/press.releases/RLC.Labs/Swine.Influenza.RLC.Statement.pdf

Swine Flu and Pork-derived Desiccated Thyroid Products:Is there Reason for Concern?
Article by Dr John Lowe - http://www.thyroidscience.com/

Article by Mary Shomon - http://thyroid.about.com/b/2009/04/26/pig-thyroid-drugs-swine-flu.htm

Sunday 26th July - Bridge Club rooms, 57 Hillside Rd, Papatoetoe

contact Margaret ph 09-534-2158

held every 2 months

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contact Tracey ph 03-382-0498

held every 2 months

Definition
Graves' disease is the most common form of hyperthyroidism. It occurs when your immune system mistakenly attacks your thyroid gland and causes it to overproduce the hormone thyroxine.
The abnormal immune response can affect the tissue behind your eyes as well as parts of your skin. The higher thyroxine level in Graves' disease can greatly increase your body's metabolic rate, leading to host of health problems.
Graves' disease is rarely life-threatening. Although it may develop at any age and in either men or women, Graves' disease is more common in women and usually begins after age 20.
There's no way to stop your immune system from attacking your thyroid gland, but treatments for Graves' disease can ease symptoms and decrease the production of thyroxine.

Symptoms may include:
Anxiety
Irritability
Difficulty sleeping
Fatigue
A rapid or irregular heartbeat
A fine tremor of your hands or fingers
An increase in perspiration
Sensitivity to heat
Weight loss, despite normal food intake
Brittle hair
Enlargement of your thyroid gland (goiter)
Light menstrual periods
Frequent bowel movements

Graves' ophthalmopathy
It's also fairly common for your eyes to exhibit mild signs of a condition known as Graves' ophthalmopathy. In Graves' ophthalmopathy, your eyeball bulges out past its protective orbit (exophthalmos). This occurs as tissue and muscles behind your eyes, swell and cause the eyeball to move forward. Because your eye is so far forward, the front surface of your eye can become dry. Cigarette smokers with Graves' disease are more likely to have eye problems.

Graves' ophthalmopathy may cause these mild signs and symptoms:
Excess tearing and sensation of grit or sand in either or both eyes
Reddened or inflamed eyes
Widening of the space between your eyelids
Swelling of the lids and tissues around the eyes
Light sensitivity

Less often, Graves' ophthalmopathy can produce these signs and symptoms:
Ulcers on the cornea
Double vision
Limited eye movements
Blurred or reduced vision
Graves' dermopathy
An uncommon sign of Graves' disease is reddening and swelling of the skin, often on your shins and on the top of your feet, called Graves' dermopathy.

Causes
Normally, your immune system uses naturally occurring proteins (antibodies) and white blood cells (lymphocytes) to help eliminate viruses, bacteria and foreign substances (antigens) that invade your body.

In Graves' disease, your immune system mistakenly attacks your thyroid gland, but instead of destroying the gland, an antibody called thyrotropin receptor antibody (TRAb) stimulates the thyroid to make excessive amounts of thyroid hormone.

Your thyroid is part of your endocrine system, which includes a collection of glands and tissues that produce hormones. These chemical messengers coordinate many of your body's activities, from digestion to metabolism to reproduction. Thyroxine — a hormone produced by the thyroid — controls your metabolic rate.

Doctors don't know the cause of Graves' disease, what may lead your immune system to attack your thyroid gland. However, they believe a combination of factors, including heredity, sex, age and stress, may determine your likelihood of developing Graves' disease.

When to seek medical advice
See your doctor if you have signs and symptoms suggesting Graves' disease, which may include an enlarged thyroid, protruding eyes, anxiety, intolerance to heat, tremor and weight loss. Go to an emergency room if you are experiencing heart-related signs and symptoms, such as a rapid or irregular heartbeat.

Tests and diagnosis
To diagnose Graves' disease, your doctor typically uses these procedures:
Physical exam. Your doctor examines your eyes to see if they're irritated or protruding and looks to see if your thyroid gland is enlarged. Because Graves' disease increases your metabolism, your doctor will check your pulse and blood pressure and look for signs of trembling. Your doctor will also ask you about your symptoms and your personal and family medical histories.
Blood sample. Your doctor will order blood tests to determine your levels of thyroid-stimulating hormone (TSH) and thyroxine. TSH, produced by your pituitary gland, is the hormone that normally stimulates the thyroid gland. In Graves' disease, an abnormal antibody called TRAb mimics TSH, causing elevated thyroxine even while TSH levels remain low. If you have very low levels of TSH and high levels of thyroxine, your doctor may diagnose Graves' disease.
Radioactive iodine uptake. Your body needs iodine to make thyroxine. By giving you a small amount of radioactive iodine and later measuring the amount of radioactive iodine in your thyroid gland, your doctor can determine the rate at which your thyroid gland takes up iodine. A high uptake of radioactive iodine indicates your thyroid gland is producing too much thyroxine, as is the case in Graves' disease. Low uptake occurs in some of the other causes of hyperthyroidism.

Complications
Any time your body produces too much thyroid hormone, because of Graves' disease or another cause, it can lead to a number of complications:

Heart problems. Some of the most serious complications of hyperthyroidism involve the heart. These include a rapid heart rate, a heart rhythm disorder called atrial fibrillation and congestive heart failure — a condition in which your heart can't circulate enough blood to meet your body's needs. These complications are generally reversible with appropriate treatment.
Brittle bones. Untreated hyperthyroidism can also lead to weak, brittle bones (osteoporosis). The strength of your bones depends, in part, on the amount of calcium and other minerals they contain. Too much thyroid hormone interferes with your body's ability to incorporate calcium into your bones.
Thyrotoxic crisis. Hyperthyroidism also places you at risk of thyrotoxic crisis — a sudden intensification of your signs and symptoms, leading to a fever, a rapid pulse and even delirium. This complication is rare, but if it occurs, seek immediate medical care.

Treatments and drugs
There's no treatment to stop your immune system from producing the antibodies that cause Graves' disease. Treatments to control the signs and symptoms of Graves' disease are designed to decrease the production of thyroxine or to block its action. Graves' disease treatment includes:

Beta blockers. These medications, which include propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor) and nadolol (Corgard), often relieve hyperthyroid signs and symptoms, such as a rapid heart rate, nervousness and tremors. These medications aren't a cure for Graves' because your body will still produce too much thyroxine, but beta blockers block some of the action of the thyroid hormone. Beta blockers are often used in conjunction with other forms of treatment.
Anti-thyroid medications. These prescription medications, including propylthiouracil and methimazole (Tapazole), prevent your thyroid from producing excessive amounts of hormones. Typically, treatment with anti-thyroid medications continues for at least a year. For some people with Graves' disease, treatment with anti-thyroid medications for one to two years causes a long-term remission of the disease. However, relapse is fairly common. These drugs are often used along with radioactive iodine treatment or surgery to help control signs and symptoms.
Radioactive iodine treatment. To make thyroid hormone, your body needs iodine and uses whatever form of iodine is available in your blood. If you take radioactive iodine, the iodine collects in your thyroid gland, and over time the radioactivity destroys the overactive thyroid cells. This causes your thyroid gland to shrink, and problems lessen gradually, usually over several weeks to several months.

Because this treatment causes thyroid activity to decline, you'll likely later need thyroxine treatment to supply your body with normal amounts of thyroid hormones. Treatment doesn't require a hospital stay.

Radioactive iodine treatment may increase your risk of new or worsened symptoms of Graves' ophthalmopathy. This side effect is usually mild and temporary, but radioactive iodine therapy may not be recommended if you already have moderate to severe eye problems. After radioactive iodine treatment, any iodine not taken up into the thyroid gland is excreted in your urine and saliva.

Surgery. If you can't tolerate an anti-thyroid drug and don't want to have radioactive iodine therapy, surgery to remove your thyroid gland (thyroidectomy) is an option. After the surgery, you'll likely need thyroxine treatment to supply your body with normal amounts of thyroid hormones.

Risks of this surgery include potential damage to your vocal cords and your parathyroid glands, tiny glands located adjacent to your thyroid gland. Your parathyroid glands produce a hormone that controls the level of calcium in your blood. Complications are rare under the care of a surgeon experienced in thyroid surgery.

Treating Graves' ophthalmopathy
If Graves' disease affects your eyes (Graves' ophthalmopathy), you can manage mild symptoms by using artificial tears liberally during the day and lubricating gels at night. If your symptoms are more severe, your doctor may recommend:

Medications. Treatment with prescription corticosteroids, such as prednisone, may diminish swelling behind your eyeballs.
Orbital decompression surgery. In this surgery, your doctor removes the bone between your eye socket (orbit) and your sinuses — the air spaces next to the orbit. This gives your eyes room to move back to their original position. Possible complications include double vision and lip numbness.
Eye muscle surgery. The inflammation caused by Graves' disease can affect your eye muscles, making them too short to allow the eyes to align properly. In eye muscle surgery, your doctor cuts the muscle where it attaches to your eyeball and then reattaches it farther back. Sometimes, more than one operation is necessary.
Prisms. You may have double vision either because of Graves' disease or as a side effect of surgery for Graves' disease. Though they don't work for everyone, prisms in your glasses may correct your double vision.
Orbital radiotherapy
Orbital radiotherapy was once a common treatment for Graves' ophthalmopathy. Orbital radiotherapy uses targeted X-rays over the course of several days to destroy some of the tissue behind your eyes. However, some studies have suggested that this treatment provides no benefit for people who have mild to moderately severe Graves' ophthalmopathy.

Your doctor may recommend orbital radiotherapy if your eye problems are worsening and prescription corticosteroids alone aren't effective or well tolerated.

Lifestyle and home remedies
For Graves' ophthalmopathy
These steps may make your eyes feel better if you have Graves' ophthalmopathy:
Apply cool compresses to your eyes. The added moisture may soothe your eyes.
Wear sunglasses. When your eyes protrude, they're more vulnerable to ultraviolet rays and more sensitive to bright light. Wearing sunglasses that wrap around the sides of your head will lessen the irritation of your eyes from the wind.
Use lubricating eyedrops. Eyedrops may relieve the dry, scratchy sensation on the surface of your eyes. At night, a paraffin-based gel such as Lacri-Lube can be applied.
Elevate the head of your bed. Keeping your head higher than the rest of your body lessens fluid accumulation in the head and may relieve the pressure on your eyes.
For Graves' dermopathy
If the disease affects your skin (Graves' dermopathy), use over-the-counter creams or ointments containing hydrocortisone to relieve swelling and reddening. In addition, using compression wraps on your legs may help.

Hashimoto's Disease

Definition
Hashimoto's disease causes inflammation of your thyroid, a butterfly-shaped gland located at the base of your neck, just below your Adam's apple. Although it weighs less than an ounce, the thyroid gland has an enormous effect on your health. It's part of your endocrine system, which is made up of several glands and tissues that produce hormones. These chemical messengers coordinate many of your body's activities, from digestion to metabolism to reproduction.

Hashimoto's disease is an autoimmune disorder in which your immune system inappropriately attacks your thyroid gland, causing damage to your thyroid cells and upsetting the balance of chemical reactions in your body. The inflammation caused by Hashimoto's disease, also known as chronic lymphocytic thyroiditis, often leads to an underactive thyroid gland (hypothyroidism). Hashimoto's disease is the most common cause of hypothyroidism in the United States.

Doctors use blood tests of thyroid function to detect Hashimoto's disease. Treatment of Hashimoto's disease with thyroid hormone replacement medication usually is simple and effective.

Symptoms
Hashimoto's disease does not have unique signs and symptoms. The disease typically progresses slowly over a number of years and causes chronic thyroid damage, leading to a drop in thyroid hormone levels in your blood. The signs and symptoms, if any, are those of an underactive thyroid gland (hypothyroidism).

The signs and symptoms of hypothyroidism vary widely, depending on the severity of hormone deficiency. At first, you may barely notice any symptoms, such as fatigue and sluggishness, or you may simply attribute them to getting older. But as the disease progresses, you may develop more obvious signs and symptoms, including:

Increased sensitivity to cold
Constipation
Pale, dry skin
A puffy face
Hoarse voice
An elevated blood cholesterol level
Unexplained weight gain — occurring infrequently and rarely more than 10 to 20 pounds, most of which is fluid
Muscle aches, tenderness and stiffness, especially in your shoulders and hips
Pain and stiffness in your joints and swelling in your knees or the small joints in your hands and feet
Muscle weakness, especially in your lower extremities
Excessive or prolonged menstrual bleeding (menorrhagia)
Depression
Without treatment, signs and symptoms gradually become more severe and your thyroid gland may become enlarged (goiter). In addition, you may become more forgetful, your thought processes may slow, or you may feel depressed.

Causes
Your thyroid gland produces two main hormones, thyroxine (T-4) and triiodothyronine (T-3). They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate and help regulate the production of protein.

The rate at which thyroxine and triiodothyronine are released is controlled by your pituitary gland and your hypothalamus — an area at the base of your brain that acts as a thermostat for your whole system. The hypothalamus signals your pituitary gland to make a hormone called thyroid-stimulating hormone (TSH). Your pituitary gland then releases TSH — the amount depends on how much thyroxine and triiodothyronine are in your blood. Finally, your thyroid gland regulates its production of hormones based on the amount of TSH it receives. Although this process usually works well, the thyroid sometimes fails to produce enough hormones.

Your immune system's role
Normally, your immune system uses naturally occurring proteins (antibodies) and white blood cells (lymphocytes) to help protect against viruses, bacteria and foreign substances (antigens) that invade your body. Hashimoto's disease is an autoimmune disorder in which your immune system creates antibodies that damage your thyroid gland. The disease causes inflammation of your thyroid gland (thyroiditis), which may impair the ability of your thyroid to produce hormones, leading to an underactive thyroid gland (hypothyroidism). Then, your pituitary gland attempts to stimulate your thyroid gland to produce more thyroid hormones, thus causing your thyroid gland to enlarge (goiter).

Doctors don't know what causes your immune system to attack your thyroid gland. Some scientists think a virus or bacterium might trigger the response, while others believe a genetic flaw may be involved. Most likely, Hashimoto's disease results from more than one factor. A combination of factors, including heredity, sex and age, may determine your likelihood of developing the disorder. Hashimoto's disease is most common in middle-aged women and tends to run in families.

When to seek medical advice
See your doctor if you're feeling tired for no apparent reason or have any other signs and symptoms of hypothyroidism, such as dry skin, a pale, puffy face, constipation or a hoarse voice.

You'll also need to see your doctor for periodic testing of your thyroid function if you've had previous thyroid surgery, treatment with radioactive iodine or anti-thyroid medications, or radiation therapy to your head, neck or upper chest.

If you have high blood cholesterol, talk to your doctor about whether hypothyroidism may be a cause. And if you're receiving hormone therapy for hypothyroidism caused by Hashimoto's disease, schedule follow-up visits as often as your doctor recommends. Initially, it's important to make sure you're receiving the correct dose of medicine. And over time, the dose you need to adequately replace your thyroid function may change.

Tests and diagnosis
In general, your doctor may test for Hashimoto's disease if you're feeling increasingly tired or sluggish, have dry skin, constipation and a hoarse voice, or have had previous thyroid problems or goiter.

Diagnosis of Hashimoto's disease is based on your signs and symptoms and the results of blood tests that measure levels of thyroid hormone and thyroid-stimulating hormone (TSH). These may include:

A hormone test. Blood tests can determine the amount of hormones produced by your thyroid and pituitary glands. If your thyroid is underactive, the level of thyroid hormone is low. At the same time, the level of TSH is elevated because your pituitary gland tries to stimulate your thyroid gland to produce more thyroid hormone.
An antibody test. Because Hashimoto's disease is an autoimmune disorder, the cause involves production of abnormal antibodies. A blood test may confirm the presence of such antibodies.
In the past, doctors were unable to detect underactive thyroid (hypothyroidism), the main indicator of Hashimoto's disease, until signs and symptoms were fairly advanced. But by using the sensitive TSH test, doctors are able to diagnose thyroid disorders much earlier, often before you experience any signs and symptoms. Because the TSH test is the best screening test, your doctor will likely check TSH first and follow with a thyroid hormone test if needed. TSH tests also play an important role in managing hypothyroidism. These tests also help your doctor determine the right dosage of medication, both initially and over time.

Complications
Left untreated, an underactive thyroid gland (hypothyroidism) caused by Hashimoto's disease can lead to a number of health problems:

Goiter. Constant stimulation of your thyroid to release more hormones may cause the gland to become enlarged, a condition known as goiter. Hypothyroidism is one of the most common causes of goiter. Although generally not uncomfortable, a large goiter can affect your appearance and may interfere with swallowing or breathing.
Heart problems. Hashimoto's disease also may be associated with an increased risk of heart disease, primarily because high levels of low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — can occur in people with an underactive thyroid gland (hypothyroidism). Hypothyroidism caused by Hashimoto's disease also can lead to an enlarged heart and, in rare cases, heart failure.
Mental health issues. Depression may occur early in Hashimoto's disease and may become more severe over time. Hashimoto's disease can also cause sexual desire (libido) to decrease in both men and women and can lead to slowed mental functioning.
Myxedema. This rare, life-threatening condition can develop due to long-term hypothyroidism as a result of untreated Hashimoto's disease. Its signs and symptoms include intense cold intolerance and drowsiness followed by profound lethargy and unconsciousness. A myxedema coma may be triggered by sedatives, infection or other stress on your body. Myxedema requires immediate emergency medical treatment.
Birth defects. Babies born to women with untreated Hashimoto's disease may have a higher risk of birth defects than may babies born to healthy mothers. Doctors have long known that these children are more prone to intellectual and developmental problems. There may be a link between hypothyroid pregnancies and birth defects, such as cleft palate. A connection also exists between hypothyroid pregnancies and heart, brain and kidney problems in infants. However, if any of these conditions are diagnosed within the first few months of a baby's life, chances of normal development are excellent.

Treatments and drugs
Treatment for Hashimoto's disease may include observation and use of medications. If there's no evidence of hormone deficiency and your thyroid is functioning normally, your doctor may suggest a wait-and-see approach.

Synthetic hormones
If Hashimoto's disease causes thyroid hormone deficiency, you may need replacement therapy with thyroid hormone. This usually involves daily use of the synthetic thyroid hormone levothyroxine (Levothroid, Levoxyl, Synthroid). Synthetic levothyroxine is identical to thyroxine, the natural version of this hormone made by your thyroid gland. The oral medication restores adequate hormone levels, returning your body to its normal functioning.

Soon after starting treatment, you'll notice that you're feeling less fatigued. The medication also gradually lowers cholesterol levels elevated by the disease and may reverse any weight gain. Treatment with levothyroxine is usually lifelong, but because the dosage you need may change, your doctor is likely to check your TSH level every six to 12 months.

Monitoring the dosage
To determine the right dosage of levothyroxine initially, your doctor generally checks your level of TSH after a month or two. Excessive amounts of the hormone can accelerate bone loss, which may make osteoporosis worse or add to your risk of this disease. Overtreatment with levothyroxine also can cause heart rhythm disorders (arrhythmias).

If you have coronary artery disease or severe hypothyroidism, your doctor may start treatment with a smaller amount of medication and gradually increase the dosage. Progressive hormone replacement allows your heart to adjust to the increase in metabolism.

Levothyroxine causes virtually no side effects when used in the appropriate dose and is relatively inexpensive. If you change brands, let your doctor know to ensure you're still receiving the right dosage. Also, don't skip doses or stop taking the drug because you're feeling better. If you do, signs and symptoms will gradually return.

Effects of other substances
Certain medications, supplements and even some foods may affect your ability to absorb levothyroxine. Talk to your doctor if you eat large amounts of soy products or a high-fiber diet, or if you take any of the following:

Iron supplements including multivitamins that contain iron
Cholestyramine (Questran), a medication used to lower blood cholesterol levels
Aluminum hydroxide, which is found in some antacids
Sodium polystyrene sulfonate (Kayexalate), used to prevent high blood potassium levels
Sucralfate, an ulcer medication
Calcium supplements

Alternative medicine
Most doctors recommend levothyroxine, the synthetic form thyroxine (T-4). However, natural extracts are available that contain thyroid hormone derived from the thyroid glands of pigs. These products — Armour Thyroid or Naturethroid (which is available in New Zealand under the name Whole Thyroid Extract), for example — contain both levothyroxine and triiodothyronine (T-3), as well as traces of T2, T1 & Calcitonin.

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