Kirklin Clinic Head & Neck Cancer Support Group, Birmingham, AL
distributed by American Cancer Society
Pat Sanders, Editor
Laryngectomees and Thyroid Problems by Pat Sanders
Do all laryngectomees have problems with hypothyroidism? The answer is no, but the percentages of those who are hypothyroid after receiving treatments for throat cancer is high enough that we should all be checked. People who have had radiation for head and neck cancers, even though they have not had a laryngectomy, are high on the list of ones who should keep a check on this. Some of us had radiation some years before surgery and may never have considered that we could have been somewhat hypothyroid as the result of that radiation even before the laryngectomy was done. If, during surgery, your surgeon removes a goodly portion, or all, of your thyroid, he will be aware to check you later for hypothyroidism but radiation causes hidden damage. Damage to the thyroid can happen during surgery when the thyroid is not removed. Only your symptoms and the thyroid blood test will tell.
Actually as many as 1 in 10 women are taking their “pill for the day”, usually Synthroid, to keep their metabolism normal. The thyroid controls the metabolism. The symptoms can sneak up on you because so many are common to other illnesses, especially as we grow older, when our metabolism might normally slow down. The slowing metabolism caused by hypothyroidism affects every organ including the major ones, the brain and the heart.
The symptom everyone gets excited about is Weight Gain, because they would like to think they have something to blame it on and a pill to miraculously lose 20 pounds. Sorry, it doesn’t work quite like that. But if you become hypothyroid, you likely have water retention that, in addition to giving you swollen eyelids and a puffy face may add 5 or 6 pounds. In addition, the fatigue and sleepiness tend to have you doing less physically, so more weight might be gained from the lack of activity. It may seem odd that edema, the holding of water in the tissues, goes along with an opposite sounding symptom, dryness of the skin, hair, and fingernails as well as constipation.
How many times have you heard that old people are forgetful and confused? Some of these are probably hypothyroid and don’t know it. When you look at the list of symptoms, you will find things like inability to concentrate and loss of memory, which often is noticed more by the people around us than our noticing it ourselves. Your brain is not working at full speed when hypothyroid.
It is very common for people not to recognize the symptoms. If we are not told to be checked every year or that a particular combination of symptoms may be a thyroid problem, we are likely to blame fatigue on other things: after effects of anesthesia from surgery, multiple surgeries that have kept you weak and tired, loss of sleep, too much to do, taking care of a sick relative, or just 'overdoing it yesterday' are typical reasons to use. You might have said, "I'm so tired, I just can't think straight today." and yet still overlook it on a list of symptoms because those other problems do cause fatigue and you think that is why you are tired all the time. When someone reaches a point that fatigue is taking over and affecting the quality of life, then something is wrong. It may be mental, physical or emotional, but a thorough checkup to see what is wrong would be in order and that should include the thyroid check.
Depression is one of the worst symptoms and the one we are least likely to discuss. Many people think they are depressed because they don’t feel well or have to worry about money or kids or because they have lost interest in so many things they used to enjoy, even sex. Just having mild thyroid failure can cause depression and this is one of the hardest symptoms to pinpoint.
Other possible physical symptoms are muscle weakness, muscle and joint aches, pains, arthritis, slowed heart rate, intolerance to heat or cold, feeling cold when everyone else is comfortable or even uncomfortably warm, cold hands and feet, low temperature reading upon awakening (97 range) and a low pulse (well below 80).
You may have been to the doctor, who found high cholesterol and high triglycerides test results but, if you are hypothyroid, cholesterol will often be high so doctors should wait till your thyroid is right before using cholesterol test results to put you on medication for that separate problem.
Hardly anyone has ‘all’ of these symptoms but you may have a combination of them with one or two seeming to be of greater importance. If you think you might be hypothyroid, get tested, and if you are not, it is still wise to get checked again in a year or sooner if you start having some of these symptoms.
For thyroid, like other lab tests, it is wise to get a copy of the tests and start a folder so you have a running medical record. Your doctor’s office will be glad to make you a copy, so ask for one while you are there.
Many other tests can be affected by what is going on with your thyroid since it regulates your metabolism. When they do the blood test for cholesterol, triglycerides, and glucose, you need to fast to accurately compare from one test to another because what you have just eaten will effect the results. Thyroid function does not need to be a fasting test.
Synthroid is the most common prescription given and it, along with similar medications, is a miracle worker for us. They are inexpensive and we can’t say that about many medicines these days. This medication is one you will take daily for the rest of your life although the dosage may be changed. At first, you will be checked with some regularity (mine was 3 month intervals) to settle on the right dosage.
Many of us take our one-a-day pill by itself, in the morning, on an empty stomach at least an hour before eating or taking other medications. Be particularly careful of taking vitamins with iron or calcium any time near the thyroid medication since it will interfere with the working of the medicine. Take that after breakfast instead of before.
I have my Synthroid by my bedside and take it upon awakening. I will drink coffee but stay away from my calcium fortified orange juice until “at least” an hour after taking the Synthroid. If I awake early, I’ll take my Synthroid and roll over for another nap. It is ok to wait longer than the hour.
To educate yourself further on this subject, try the Medicinenet.com site. This is easy reading and will answer most of your questions.
There is a good index to this site which lets you find explanations of
hypothyroidism and thyroid hormones. Symptoms, diagnosis, and treatments are also explained. At the bottom of that first page that they have a link to another index with 138 additional Hypothyroidism related articles.
Looking at the sketch on the first page of the medicinenet section on hypothyroidism, you can see the normal location of the thyroid gland right in front and around the trachea. You can see exactly why it is disturbed to remove the larynx, right behind it and when reworking the trachea to end at the new stoma. You can also understand why radiation to the larynx also can damage the thyroid.
I asked my doctor a few years back what he does with or to the thyroid that is in the way when he performs a laryngectomy and he wrote the following which we published in the June 2000 issue of HeadLines. This is worth repeating
WHAT ON EARTH HAPPENED TO MY THYROID GLAND?
First, the thyroid gland is shaped like a butterfly and lies in a position adjacent to the larynx and trachea. There are two lobes, one on each side of the larynx and trachea. These lateral lobes are connected by a narrow isthmus, which crosses the trachea just below the larynx.
In doing a laryngectomy, we try to save as much of the gland as possible. Usually, we can save both of the lateral lobes, which means you are left with essentially all of your thyroid tissue. However, sometimes it is necessary to resect half, or even all, of the thyroid in order to adequately remove the cancer. When we remove the larynx, we dissect the portion of the thyroid that we are going to save off of the larynx and trachea and leave it lying in the neck on either side of the esophagus. This means that your thyroid gland is actually in two halves, one on each side of the esophagus and slightly above your stoma.
The problem with thyroid function can come in several scenarios. The first one is obvious with the need to remove all of the thyroid tissue. You will be on thyroid replacement medication before you leave the hospital. (By the way, you will also be on calcium and vitamin D replacement before your discharge as well.) The other two scenarios are more subtle. The first involves leaving some thyroid tissue but compromising the blood supply in doing the laryngectomy. What happens is the thyroid slowly gives up the ship and dies.
The last and probably the most common thing to happen is radiation therapy. The radiation causes the small blood vessels in the gland to slowly stop up so you end up with a small scarred gland with poor blood supply and inadequate function.
Does everyone who has radiation to the neck need to be on thyroid replacement medicine? The answer is “no”. If you are having the symptoms of becoming fatigued easily, low energy level, weight gain, etc., and if you have had radiation, then you should have your thyroid hormone levels checked with a simple blood test. Replacement medicine can then be given on the basis of those results.
Glenn E. Peters, M.D. , F.A.C.S.
Director, Division of Otolaryngology - Head and Neck Surgery
University of Alabama at Birmingham, Birmingham, Alabama, USA
Even if your symptoms are mild, do ask your doctor to check your thyroid and explain to him that we are at high risk for hypothyroidism. If the test is normal, that’s fine, but be careful if it is borderline normal to get checked regularly. Some people have strong symptoms when borderline and some doctors start you on a small dose of medication at that time.
The Crocheting Lady by Pat Sanders, <email@example.com>
Some years ago, as I went about calling on new laryngectomees in the hospital for UAB and American Cancer Society, I found that we hardly ever had enough stoma covers for me to take some as gifts when I made an initial visit.
One day, in looking for patterns on line, I came across the Crochet Guild of America and, noticing that they wrote about classes, I thought they might like to get new people to make a simple type of stoma cover as part of their class work. I wrote to them via email, told our needs and asked. They came back with an even better idea. They had a section for charitable works and they would put a notice in for me listing both my email and the ACS. Over the years, we have had people write for patterns and some have sent one batch, others sent many.
One of the early people I heard from was a lady who has stuck with me through the years and I cannot count how many stoma covers she has made. She had some heavier thread than we usually used and as she worked on a project with it, she tried making some with that thread, which I liked very much. I still wear these in a wild assortments of colors but, today, I wear black.
Linda and I have corresponded about family and illnesses and pets. I have pictures of her dogs and heard from her about her friends, who also crocheted some special things for us. We became friends through email, never meeting face to face but knowing there was someone there with whom we could share good and bad news. I just received the bad news. My friend has been diagnosed with Alzheimer’s Disease after having cognitive and short term memory problems for some time. This morning, I received this message from her:
“Hello dear friend,
I just want to tell you that I am doing o.k. The only thing that I can do to keep my mind and hands busy is working on stoma covers. I honestly don't know what I would do if I couldn't make the covers. I can't do so many things now and I'm so scared about the future. I am blessed with the most wonderful husband and daughter who keep me going.
I'll keep up working on the stoma covers and thank you so much for giving me the information to make them because crocheting them is somehow my life-line.”
Every day when I select the color to wear today, I think gratefully to the hours Linda has put in for me and for other laryngectomees. What more can someone leave behind than memories of kindness and caring and someone who thinks of them daily?
http://www.crochet.org Crochet Guild of America
http://webwhispers.org/pages/library/stomacovers.htm Stoma Cover Patterns