- Acid Reflux
- Being on Oxygen
- CPR and Anesthesia concerns
- Dry Mouth - Xerostomia
- Dental Issues
- Nebulizer Usage
- Neck and Shoulder Dysfunction
- Pain Management
- Peg Tube
- Recurrent Disease
- Second Primaries
- Stroke and Vascular Problems Related to Head Neck Radiation
One factor frequently overlooked by laryngectomees (and in many cases their doctors) is the possible damage done to the thyroid as a result of surgery and radiation therapy. The symptoms of hypothyroidism may include lethargy, weakness, cold intolerance, mental slowing, weight gain, and depression. They are not only associated with aging, but may be confused with chronic-fatigue syndrome and anemia. A laryngectomee should be sensitive to the possibility of under active thyroid and should ask about a simple blood test for the four main constituents of thyroid output on a yearly schedule. If your test ever shows you to be hypothyroid, a single pill a day will take care of restoring the balance but will have to be monitored for changes needed in medication. (Bob Hopkins)
The following are symptoms of hypothyroidism, as detailed by
the Merck Manual, the American Association of Clinical
Endocrinologists, and the Thyroid Foundation of America.
You will not have all of these but some fit together and can be thought to be other diseases that combine fatigue, depression, dryness
____ I am gaining weight inappropriately
____ I'm unable to lose weight with diet/exercise
____ I am constipated, sometimes severely
____ I have hypothermia/low body temperature (I feel cold
when others feel hot, I need extra sweaters, etc.)
____ I feel fatigued, exhausted
____ Feeling run down, sluggish, lethargic
____ My hair is coarse and dry, breaking, brittle, falling out
____ My skin is coarse, dry, scaly, and thick
____ I have a hoarse or gravely voice
____ I have puffiness and swelling around the eyes and face
____ I have pains, aches in joints, hands and feet
____ I have carpal-tunnel syndrome
____ I am having irregular menstrual cycles
____ I feel depressed
____ I feel restless
____ My moods change easily
____ I have feelings of worthlessness
____ I have difficulty concentrating
____ I have more feelings of sadness
____ I seem to be losing interest in normal daily activities
____ I can't seem to remember things
____ I have no sex drive
____ I am getting more frequent infections, that last longer
____ I'm snoring more lately and may have sleep apnea
____ I feel shortness of breath and tightness in the chest
____ I feel the need to yawn to get oxygen
____ My eyes feel gritty and dry
____ My eyes feel sensitive to light
____ My eyes get jumpy/tics in eyes, which creates dizziness and
____ I have strange feelings in neck or throat
____ I have tinnitus (ringing in ears)
____ I get recurrent sinus infections
____ I have vertigo
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.
LARYNGECTOMEES AND THYROID PROBLEMS
by Pat Sanders (From HEADLINES)
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. It should be taken every day but if you miss a dose, don't double up.
One of the problems and symptoms of hypothyroidism is very dry skin. Others tell me that chemotherapy also leaves this same symptoms and so does radiation. These also can leave you with yeast. You need to find out what is causing it, but , in the meantime, some of our members had a discussion of what remedies to use to ease the skin dryness.
This discussion was started by Sarah A, who wrote:I am taking erbitux as a chemo drug and my latest side effect is the skin on my fingers is cracking and causing painful cuts. It hurts to touch things, which is not helpful for getting all my holiday crafting done! My oncology nurse recommended liquid band aid but I find this quite annoying... Like when you accidentally touch crazy glue. Another nurse mentioned soaking my hands in a vinegar solution but couldn't remember how to make the solution. Has anyone here heard of this?
1. We all have our own "best" product for dry, cracked skin, particularly on the hands. My best product is Beauchamps Hand Lotion. It's very liquid and does not seem like it would do much, but it really is a miracle worker. It probably could be used on the feet or other places, but I would not use it around the stoma - it has camphor as an ingredient. It comes in 8 oz. and
16 oz. bottles. 8 oz. lasts me a year.
It is compounded in a drug store in Rutland Vermont and is only available there and on line at www.beauchampshandlotion.com.
Carl Strand '93
2. I have found a product called O'Keefe's Working Hands (green colored canister) and also O'Keefes Working feet (blue colored canister) which works wonderful as I have serious problems with my fingers cracking open and bleeding during the dry winter months in Minnesota, maybe due to all the lymph glands I have had removed during to cancer surgery operations to insure there was no further spread ? My son has the same type issues with his feet. This product is used by many in the "trades" whose hands are subject to severe treatments or chemicals which is where I found out about it and started buying it at a local auto parts store. They told me a lot of Mayo Clinic Dr.'s also purchase it as they have so many hand washings and use of hand sanitizers. I have found it available at most Walmart's, Targets, Ace Hardware's, Home Depot's and Lowe's, $6.00 to $7.00 a container. So the accessibility should be good for most in the USA anyway. It sure would be worth a try for the price for anyone experiencing dry skin issues.
It also was recommended I use a product called Aquaphor during my neck radiation to help with the dry skin on my radiated neck.
Wild Bill from the "State of minus zero Fahrenheit; fridged Minnesota
3. re cracking and painful finger cuts. I had the same problem for years until I found Bee Balm which she can get from Vermont BeeBalm Co. Their E mail is vermontbeebalm.com It does not sting, verysoothing. I know you will be pleased. This year I have not had anycracking. I am now, thank God, four years since becoming a lary . In July I celebrated my 90th.
4. This is my experience with Erbitux. My hands cracked severely, as did the heels on my feet. I tried the meds the doc gave me with little success, and finally found the best hand creme I could get my hands on and rode it out. (Nurses know the best brands; also there are prescription lotions.) When you put the creme or lotion on at night, wear socks and knit gloves to allow it to saturate your skin.
5. I take Xeloda and have a similar problem. I use hand cream twice a day which helps some. The lotion that seems to work the best for me is Ahava for hand and foot. Lotioning and then wearing gloves at night also helps some. I'd be interested in any other suggestions, also.
Neil Arnold 8/2011
6. In response to the post about dry hands and fingers during chemo treatments, I would strongly recommend a product called O'Keefes working hands. You can purchase it on Amazon for about $7-8 and it isa real lifesaver. I am currently going through chemo myself and this stuff worked on my hands in about 5 days.
7. I have found Palmer's Cocoa Butter Formula effective. I like the thicker kind in the jar. It used to be found at Dollar General for $3.50 a jar, but I see it in a lot of other stores now so I'll bet the price is up. Still worth it.. Lasts a long time. I don't need it as much as I used to. Yeast meds took care of extra dry skin, hair, nails and I am not hypothyroid anymore.
Pat Sanders - 3/1995
SITES FOR THYROID PROBLEMS
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 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.
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