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February 14, 2003

Daily Care, Thyroid

Question from Bellingen, New South Wales, Australia:

My 15 year old niece, who has type 1 diabetes, has been diagnosed with hyperthyroidism and has been on 2 thyroxin and 10 neonecarzole tablets for two years, is also on a lot of insulin (21 units of Humulin R with 42 Humulin L in the morning and 18 units of R with 24 units of L at supper time). Her blood sugar levels are constantly above 12 mmol/L [216 mg/dl], and since she began taking thyroid medication, she has put on weight with an excessive appetite, and she has very tight skin on her hips and thighs. Her menstruation has been heavy and painful and ever since she has had her appendix removed nine months ago she has been in constant abdominal pain. Please help us with any advice as we are desperate to get my niece back to normal. Is the dosage of neonecazole too high? What are the side effects?

Answer:

The amount of the anti-thyroidal will be titrated on what her thyroid test levels are. Depending upon her weight, the dose of insulin may be generous or not, but again, the “right” dose depends on titrating to good glucose levels. A key question to all your inquiries, I think, relates to how well you know that your daughter is, in fact, completely compliant and adherent to taking her various medications as prescribed.

The thyroid regimen that she has been prescribed is becoming increasingly popular. The “carzol” medication is a medication to inhibit the thyroid gland from producing excess thyroid hormone. Standard use of these types of anti-thyroidals is to titrate the dose to get the thyroid levels into acceptable ranges. This is labor intensive and requires very frequent testing. An alternative is to do what her doctors have prescribed: give a large dose of the anti-thyroidal to really suppress the patient’s thyroid gland, thus “putting it at rest” and then “adding back” a small dose of thyroid replacement in order to prevent HYPOthyroidism. Not uncommonly, such therapy is continued for about two years. The literature suggests that about 25% of such patients who have a successful response in two years, can achieve a lasting remission and come off treatment for the hyperthyroidism. There seems to be about an additional 25% remission for the remaining patients every two years.

Weight gain is not typically seen in hyperthyroidism (but can occur). Weight gain is more classic of hypothyroidism. The key remains her thyroid levels and her strict compliance. I would not think the appendectomy would play a role.

DS