Thyroid Problems

CASES:

1. 49 year old female; Graves disease; water-based myelograms; also diagnosed with fibromyalgia

2. 57 year old female; Grave’s disease and thyroid eye disease; 2 myelograms (unspecified); also, IBS

3. .50 year old female; thyroiditis; 3 water-based myelograms; also IBS and ?Sjogren’s

4. ? age female; thyroiditis; myodil; also: Raynaud’s

5. 66 year old female; thyroiditis; Amipaque (water-based)

6. 54 year old male; thyroiditis; Myodil

7. 59 year old female; thyroiditis; unspecified myelogram; also Ca breast, DM, FMS

8. 67 year old female; thyroiditis; myodil; also Rheumatoid arthritis

9. 59 year old female; thyroiditis; myodil and omnipaque

10. 53 year old female; thyroiditis; myodil

11. 57 year old female; thyroiditis; myodil; also DM

12. 72 year old female; thyroiditis; myodil

13. 60 year old female; thyroiditis; pantopaque and omnipaque; also, FMS

14. 70 year old female; thyroiditis; both oil and water-based myelograms

15. 60 year old female; Hypothyroid; Myodil (oil-based) myelogram; also: IBS

16. 47 year old female; Hypothyroid diagnosed in 1996; Pantopaque (=myodil); also Manic-depressive disorder

17. 41 year old female; Hypothyroid; one unspecified myelogram;

18. 38 year old female; Hypothyroid diagnosed 1991; no myelograms but had epidural steroid injection; also has Raynaud’s and duodenal ulcer

19. 50 year old female; Hypothyroid; 3 myelograms; also: vitiligo and IBS

20. 68 year old female; thyroid surgery; myodil

21. 56 year old female; thyroid surgery; myodil

22 .61 year old female; partial thyroidectomy; myodil

23. 57 year old female; Thyroid tumour; myodil

24. 62 year old female; Thyroid tumour; myodil

25. 69 year old female; lymphoma >> thyroidectomy; myodil ; also diagnosed with MS

26. 46 year old female; thyroid cyst >> hypothyroid; myelogram

27. 64 year old female; thyroid cysts, small goitre; no myelogram but ESIs; also RA, multiple allergies

TREATMENT

MEDICATION: (in current frequent use)

OPIATES (e.g. Morphine, Pethidine, Methadone, Tramadol, etc.)	171 (54%)
ANTI-INFLAMMATORY (e.g. Brufen, Mobic, Naproxen, Vioxx etc.)	144 (45%)
ANTIDEPRESSANT (commonest Amitriptyline; also Prozac, etc.)	90 (28%)
ANTICONVULSANT (e.g. Tegretol, Neurontin, Vigabatrin)	84 (26%)
MUSCLE RELAXANT (e.g. Baclofen, Robaxin, Dantrolene, Zanaflex)	34 (11%)
BENZODIAZEPINE (e.g. Diazepam, Clonazepam, Nitrazepam, etc.)	39 (12%)
DIURETICS (for fluid retention)	17 (5%)
INA ("the pump")	8 (2%)
incl. CLONIDINE	2
SCS (Spinal Cord Stimulator)	2
STEROIDS	4 (1 via portal implant)
QUININE (for muscle cramps)	3
MEXETIL	1
AXSAIN CREAM (topical capsaicin)	1
OXYBUTININ (for bladder muscle instability)	1
BETHANECOL (for urinary retention)	1
ETIDRONATE (for prevention of bone loss in osteoporosis)	1
RITALIN	1 (for epilepsy)
PARAMAX (Paracetamol + Metoclopramide)	1
SINEMET (for Parkinson’s)	1
BETAHISTINE(for Meniere’s disease)	1
NONE	10 (3%)
PARACETAMOL/ASPIRIN ONLY	4
TENS	2

Note low percentage on no medication or simple analgesia; generally, for respondents who were not on medication, this was due to inability to tolerate stronger medication due to side-effects or adverse reactions.

Most cases in the survey involved polypharmacy, with a combination of opiates with antidepressant and/or anticonvulsant being common. Anti-inflammatory medication (NSAIDS) usage was common despite a considerable number of respondents stating that they had had to discontinue use due to adverse gastric effects (e.g. gastric/duodenal ulcer, heartburn, gastric bleed), which are well-known with this type of medication.

Antidepressant medication is used at a subtherapeutic dose as regards treating depression (i.e. say 25mg amitriptyline rather than 75-150mg) it is useful for neurogenic pain. Tricyclic antidepressants are most effective, whereas SSRIs (newer type) such as Prozac are often poorly effective. Of course, in some cases, full antidepressant dose may be given to combat any depressive features compounding the physical problems.

Anticonvulsant medication is useful for neurogenic pain.

Benzodiazepines: a group of drugs including valium: used either as a muscle relaxant or to combat anxiety, or perhaps as sleeping tablets.

Both opiates and benzodiazepines are known to cause physical and psychological dependence (though the latter is not as marked in usage for analgesia as compared with recreational use) and tolerance to opiates may necessitate increasing doses for the same therapeutic effect.

Table of Contents

Introduction
Results: Epidemiology
Results: Symptoms / Signs
Summary
Thyroid Problems
NEXT: RESEARCH SURVEY 1999: Undiagnosed Cases