More information about thyroid health.Antithyroid generics Drugs.

THYROID BLOOD TESTS

2010-12-06T11:19:00.000-08:00

THYROID BLOOD TESTS
TSH Test
Most conventional doctors rely on a test known as
the TSH test to diagnose an overactive or
underactive thyroid. The TSH test is a blood test
that measures the amount of thyroid-stimulating
hormone—TSH—in your bloodstream. (The test is
sometimes also called the thyrotropin stimulating
hormone test.) Elevated TSH levels can indicate
hypothyroidism. Low or nonexistent TSH levels
can indicate hyperthyroidism.
You'll need to know what the normal values are for
the lab where your doctor sends your blood because "normal" varies from lab to lab.
Thyroid normal ranges are in tremendous flux right now. Throughout the 1980s and
1990s in North America, the "normal" TSH range was from about 0.3-0.5 at the
bottom end, to a high end of from 5.0 to 6.0. In November of 2002, the National
Academy of Clinical Biochemistry (NACB), part of the Academy of the American
Association for Clinical Chemistry (AACC), issued revised laboratory medicine
practice guidelines for the diagnosis and monitoring of thyroid disease, which
prompted the American Association of Clinical Endocrinologists (AACE) to
recommend a narrower margin of 0.3 to 3.0.In the years since the original NACB guidelines were released, most laboratories and
many doctors have yet to adopt these new guidelines, and the medical world is still
not in complete agreement about changing the guidelines. This means that for
patients who test above below 0.5, or above 3.0, whether or not you get diagnosed
and treated for a thyroid condition depends on how up-to-date both your laboratory
and practitioner are.

DIAGNOSIS AND TREATMENT

2010-12-06T11:17:00.001-08:00

The standard line about thyroid disease is that it’s “easy to diagnose, and easy to
treat.” Or, you may hear “just one blood test and we'll find out what we need to
know." While there are some cases where a thyroid condition is fairly simple to
identify, most cases are not quite that easy.
A thorough conventional medical evaluation for thyroid disease should include:
 a thorough review of your thyroid risk factors
 a thorough review of your family history and personal history
 a thorough review of your symptoms
 a medical examination, including feeling for enlargement or masses in the
thyroid, a reflex check, evaluation of skin/hair/eyes, blood pressure, heart rate
check, body temperature, weight, and lymph/node spleen exam
 clinical evaluation for thyroid-specific signs, including loss of eyebrow hair,
facial/hand/feet swelling, myxedemic patches on legs, bulging eyes, and other
signs
 blood tests
 imaging tests as needed

SIGNS AND SYMPTOMS OF THYROID DISEASE

2010-12-06T11:16:00.001-08:00

Some of the key signs and symptoms of thyroid disease include...
___ Low body temperature
___ Particularly low or high pulse
___ Unusually low or high blood pressure
___ Enlarged, tender, or sensitive neck or lump in neck
___ Hoarse, husky, or gravelly voice
___ Extreme thirst or hunger
___ Noticeable change in weight (gain or loss) despite no change in diet and
exercise
___ Feeling warm or hot when others are cold, or cold when others are warm
___ Heart palpitations, flutters, skipped beats, strange patterns or rhythms
___ Constipation and or diarrhea/loose stools
___ Fatigued, weakness
___ Pains, aches, and stiffness in various joints, hands, and feet.
___ Carpal tunnel, tarsal tunnel, plantar’s fascitis
___ Puffiness around my eyes
___ Loss of outer eyebrow hair
___ Lesions on lower legs, feet, toes, arms, face, shoulders and/or trunk.
___ Hair loss
___ Dry eyes
___ Swollen hands or feet
___ Dry, sensitive, gritty or achy eyes
___ Changeable moods
___ Brain fog, difficulty concentrating or remembering
___ Depression
___ Anxiety, panic attacks, jumpy
___ Tremors
___ Insomnia
___ Irregular periods
___ Low sex drive
___ Infertility
___ Miscarriage or multiple miscarriages
___ Difficulty breastfeeding
___ Leaking milk when not lactating or breastfeeding
___ Difficult perimenopause/menopause symptoms

Nodules/Lumps

2010-12-06T11:11:00.000-08:00

Many people have nodules in the thyroid, but few are palpable (capable of being felt
externally). Thyroid nodules are actually fairly common. An estimated one in 12 to 15
women and one in 50 men has a thyroid nodule. In some cases, nodules on the
thyroid exist without any disease, don't have any active function, and cause no
symptoms. Some nodules impair the thyroid's ability to function properly and cause
hypothyroidism. In some cases, nodules are overactive and produce far too much
thyroid hormone -- these are called "toxic nodules," and can trigger hyperthyroidism.
Particularly large nodules can compromise breathing or swallowing. A very small
percentage of nodules are cancerous. In non-pregnant patients, 90 to 95 percent of
nodules are benign. In pregnant women, however, approximately 27% of nodules are
cancerous.
Symptoms of nodules depend on what action they are having. Some people will have
no symptoms, while others may have more hyperthyroid symptoms such as palpitations, insomnia, weight loss, anxiety, and tremors. Nodules can also trigger
hypothyroidism, and symptoms might include weight gain, fatigue, depression. Some
people will cycle back and forth between hyperthyroid and hypothyroid symptoms.
Others may have difficulty swallowing, a feeling of fullness, pain or pressure in the
neck, a hoarse voice, or neck tenderness. And finally, many people have nodules with
no obvious symptoms related to thyroid dysfunction at all.
Depending on the results of the evaluation, nodules may be left alone and monitored
periodically, assuming they aren't causing serious difficulty, or treated with thyroid
hormone replacement to help shrink them. They will be surgically removed if they are
causing difficulties with breathing, or if test results indicate a suspected malignancy.

Goiter/Enlargement

2010-12-06T11:10:00.000-08:00

Goiter is the term used to describe an enlargement of the thyroid gland. The thyroid
gland can enlarge as a response to deficiencies of iodine, thyroid inflammation or
infection, or autoimmune disease. The thyroid becomes large enough so that it can be
seen as enlarged on ultrasounds or x-rays, and may be enlarged enough to thicken the
neck area visibly. Particularly large goiters may be cosmetically problematic, and can
compromise breathing and swallowing, and are often surgically removed. Smaller
goiters may respond to drug treatment.
Symptoms of goiter include a swollen, tender or tight feeling in the neck or throat,
hoarseness or coughing, and difficulty swallowing or breathing.
Goiter can be due to an autoimmune condition that triggers an inflamed thyroid, or
due to too much or too little iodine in the diet. In the U.S., 10 to 20 percent of goiters
are iodine-induced.
 Treatment for goiter depends on how enlarged the thyroid has become, as well
as other symptoms. Treatments can include:
 Observation and monitoring, which is typically done if your goiter is not large
and is not causing symptoms or thyroid dysfunction
 Medications, including thyroid hormone replacement, which can help shrink
your goiter, or aspirin or corticosteroid drugs, to shrink thyroid inflammation.
If the goiter is very large, continues to grow while on thyroid hormone, or symptoms
continue, or the goiter is in a dangerous location, i.e., the windpipe or esophagus, or
cosmetically unsightly, most doctors will recommend surgery. If the goiter contains
any suspicious nodules, you may also need surgery.

Autoimmune Thyroid Disease

2010-12-06T11:08:00.000-08:00

There are two different autoimmune diseases in which an immune system
dysfunction targets the thyroid - Graves' disease and Hashimoto's disease. In the
United States, the vast majority of thyroid patients are either hypothyroid or
hyperthyroid due to an autoimmune disease.
Hashimoto's disease is the most common form of thyroiditis, an inflammation of the
thyroid, and so the condition is also often referred to as Hashimoto's thyroiditis. It is
far more common than Graves' disease, and is the cause of most hypothyroidism in the U.S. In Hashimoto's, antibodies react against proteins in the thyroid, causing
gradual destruction of the gland itself. Occasionally, before the thyroid is destroyed, it
has thyrotoxic periods -- known as Hashitoxicosis -- during which the thyroid
overproduces thyroid hormone. Eventually however, the gland's attack on itself
destroys the ability to produce the thyroid hormones the body needs.

Symptoms of Hashimoto's disease usually parallel the hypothyroidism that results, however, the thyroid can
periodically sputter into life during Hashitoxic periods, causing hyperthyroidism symptoms. For most
people, treatment is for hypothyroidism and involves life-long thyroid hormone replacement. Holistic and integrative
approaches tend to look at healing the underlying autoimmune imbalance, and may
include nutritional support for the thyroid (i.e., selenium, tyrosine, B vitamins, etc.)
and overall support for the immune system.
Graves' disease -- sometimes referred to as diffuse toxic goiter because of the usual
presence of a goiter -- typically causes hyperthyroidism. In the U.S., it's thought that
Graves' disease and hyperthyroidism affect slightly less than 1 percent of the US
population, or slightly less than 2.9 million people. Some experts believe, however,
that as many as 4 percent of Americans, or 11.8 million people, may have a mild,
subclinical Graves' disease, with few or no symptoms, but exhibit blood test
evidence of slight hyperthyroidism.

In Graves' disease, autoantibodies bind to the gland, which causes the thyroid to
overproduce hormone, and cause hyperthyroidism. Treatment for Graves' disease
follow hyperthyroidism treatment, and involves antithyroid drugs, radioactive iodine
ablation, or surgical removal of the thyroid. Most Graves' disease patients end up
hypothyroid over time, requiring life-long thyroid hormone replacement.

COMMON THYROID DISEASES AND CONDITIONS(part2)

2010-12-06T11:06:00.001-08:00

Conventional treatment in the U.S. focuses on disabling the thyroid permanently, by
administering radioactive iodine (RAI) treatment, which renders most patients
hypothyroid for life. Some physicians in the U.S. use prescription antithyroid drugs
such as propylthiouracil (PTU) and methimazole (Tapazole) and beta blockers to
calm down the thyroid and the immune system, with the hope of remission of the
disease, which occurs in as many as 30% of patients. (Antithyroid drugs are the first
choice, however, for doctors outside the U.S.)
In rarer cases in the U.S., and more commonly outside the U.S., surgery to remove
the thyroid may be the treatment. Holistic and integrative treatments prior to RAI or
surgery focus on supplementing antithyroid drug approaches with natural antithyroid
foods, supplements and herbs that have no side effects, as well as calming and
rebalancing the immune system through nutrition, herbs, supplements, movement
therapy such as yoga, and energy work. Ultimately, most people with Graves' disease
and hyperthyroidism do end up hypothyroid for life as a result of RAI or surgery.

COMMON THYROID DISEASES AND CONDITIONS

2010-12-06T11:05:00.001-08:00

There are a number of conditions that can affect the thyroid, its function and
structure:
Hypothyroidism/Underactive Thyroid
Hypothyroidism means that the there is too little thyroid hormone. This can be due
to a missing or undeveloped thyroid, a surgically removed thyroid, or a thyroid that is
not capable of producing enough hormone due to radioactive treatment, drugs,
nutritional deficiencies, nodules, infection, or atrophy. Symptoms of hypothyroidism
tend to mirror the slowed metabolism that results from insufficient thyroid hormone,
and include fatigue, weight gain, constipation, fuzzy thinking, depression, body pain,
slow reflexes, and much more.
Conventional treatment typically involves replacing the missing thyroid hormone
using prescription thyroid hormone replacement drugs. Most commonly, a
levothyroxine (T4) drug is prescribed, as this is considered the "standard" treatment
for hypothyroidism. The most prescribed levothyroxine drug is Synthroid, however,
the other name levothyroxine drugs (including Levoxyl and Levothroid) are
considered equivalent in quality, potency and effectiveness, and are less expensive.
Research has shown, however, that some patients feel better with the addition of a
second hormone, T3, and so some numbers practitioners are prescribing either
levothyroxine plus a synthetic T3 (Cytomel), or less commonly, levothyroxine plus
specially compounded T3.Another option is a synthetic T4 plus T3 combination drug known as liotrix
(Thyrolar). While this drug is not very commonly prescribed, it is a safe and effective
option for some patients.
Finally, some practitioners and patients prefer natural, desiccated thyroid, which has
been available for treating hypothyroidism for 100 years. The most well known
brands are Armour Thyroid and Nature-Throid. While some physicians disparage
natural thyroid and claim that it’s less effective than synthetic thyroid drugs, other
practitioners and patients prefer these natural drugs
Hyperthyroidism/Overactive Thyroid -- Thyrotoxicosis
Thyrotoxicosis refers to the various effects of exposure to too much thyroid
hormone. Hyperthyroidism implies that this excess of hormones originated in the
thyroid gland itself, and not, for example, by taking too much of your thyroid
medication. Hyperthyroidism can be caused by a number of thyroid problems,
including autoimmune thyroid disease, nodules that produce thyroid hormone,
overdosage of thyroid hormone replacement drugs, infection, and other causes.
Hyperthyroidism is typically treated by drugs to reduce the thyroid's ability to
produce hormone, by radioactive iodine treatment to chemically ablate the thyroid, or
by surgery.
Symptoms of hyperthyroidism tend to mirror the rapid metabolism that results from
an oversupply of thyroid hormone, and include anxiety, insomnia, rapid weight loss,
diarrhea, high heart rate, high blood pressure, eye sensitivity/bulging and vision
disturbances, and many other concerns.

ABOUT THE THYROID Disease(part2)

2010-12-06T11:04:00.000-08:00

When it occurs during pregnancy, mild iodine deficiency in a pregnant mother can
cause cognitive and developmental problems in her children that may reduce their IQ
by as much as 15 IQ points. But serious iodine deficiency in a pregnant woman can
cause stillbirth, miscarriage, and in particular, a congenital abnormality known as
cretinism in her child. Cretinism is a serious, irreversible condition often involving
severe mental retardation, and is most common in iodine-deficient areas of Africa
and Asia.
In the U.S., the majority of thyroid conditions is due to autoimmune disease, and in
particular, Hashimoto's disease. Thyroid disease prevalence increases with age and is
more common in women. A woman in the U.S. faces as high as a one in five chance
of developing a thyroid problem during her lifetime, and generally, women are seven
to eight times more likely than men to develop thyroid conditions.
Besides iodine deficiency and being a woman, there are a number of risk factors for
thyroid disease. These include genetics and heredity, personal or family history of
endocrine or autoimmune disease, infection, exposure to goitrogenic foods, cigarette
smoking, pregnancy, certain drugs, particular chemical exposures, radiation exposure,
and many other factors.
The most common health issues affecting the thyroid include:
 Hypothyroidism -- the condition whereby the thyroid is not producing enough
-- or any -- thyroid hormone. Congenital hypothyroidism is present at birth,
usually due to a missing or poorly developed thyroid gland.
 Hyperthyroidism -- the condition whereby the thyroid is producing too much
thyroid hormone
 Autoimmune Thyroid Disease -- Hashimoto's Disease is an autoimmune
disease that typically causes hypothyroidism. Graves' Disease typically causes
hyperthyroidism.
 Goiter -- enlargement of the thyroid
 Nodules -- lumps or masses in the thyroid, benign
 Thyroiditis -- viral, autoimmune, or post-pregnancy inflammation of the
thyroid, causing hyperthyroidism, hypothyroidism, or alternating
hyperthyroidism and hypothyroidism after pregnancy, sometimes temporary
or transient.
 Thyroid cancer -- cancerous nodules or tissue in the thyroid

ABOUT THE THYROID Disease

2010-12-06T11:02:00.000-08:00

The thyroid is a small gland, shaped like a butterfly or bowtie, located in the lower
part of your neck, in front of your windpipe. Like other glands, the thyroid secretes
hormones. The main hormones released by the thyroid -- triiodothyronine,
abbreviated as T3, and thyroxine,
abbreviated as T4 -- deliver energy to cells
of the body.
Thyroid hormones control your metabolism
—the process by which oxygen and
calories are converted to energy for use by
your cells and organs.
When your thyroid works normally, it produces and secretes the amount of T4 and
T3 necessary to keep various bodily functions moving at their proper pace. The
thyroid frequently is a common target of disease or dysfunction. It's estimated that
more than 200 million people at minimum worldwide have thyroid disease, and some
experts estimate that anywhere from 30 to 59 million Americans have thyroid disease.
The thyroid requires iodine -- usually ingested through the diet -- to produce thyroid
hormone. Thyroid problems are particularly common in areas covered at one time by
glaciers, where iodine is not present in the soil and in foods. In many of these
countries, an enlarged thyroid, known as goiter, is seen in as many as one in five
people, and is usually due to iodine deficiency.
According to the World Health Organization, iodine deficiency is the world's most
prevalent – yet easily preventable – cause of brain damage. It affects more than 740
million people worldwide -- 13% of the world's population. As many as an additional
30% of the population worldwide is at risk of iodine deficiency-related problems. In
the U.S., use of iodized salt helped reduce iodine deficiency, but as many as 20% of
Americans are still iodine-deficient.

Causes of Thyroid Cancer

2010-12-05T08:52:00.001-08:00

The thyroid is a butterfly-shaped gland located at the front and base of the throat. It is largely responsible for regulating the body's metabolism. An overactive thyroid can cause weight loss; an inactive thyroid can cause weight gain. About 37,000 cases of thyroid cancer are reported each year, according to the American Cancer Society. Although doctors are still unable to determine exactly why some people get thyroid cancer, they do know that it can be caused by radiation exposure. Genetics can play a role, too, along with a host of other risk factors. Thyroid cancer is often successfully treated with surgery, radiation and chemotherapy. On average, 97 percent of people with thyroid disease are still alive five years after diagnosis. The success of treatment can hinge on how early the cancer is detected, the type of thyroid cancer and a patient's general health. Symptoms of thyroid cancer include a lump in the neck, trouble breathing, difficulty swallowing and hoarseness.
Radiation

After explosions in 1986 wracked the Chernobyl nuclear power plant in the former Soviet Union, an estimated 5 million people were exposed to radiation, and rates of thyroid cancer soared, a host of scientific studies found. In the U.S., scientists from the National Cancer Institute in 1997 concluded that America's nuclear testing program in the 1950s and 1960s had produced dangerous radioactive iodine-131 fallout that raised risks of thyroid cancer.
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Genetic Conditions

Medical scientists have found that thyroid cancer can be caused by the inheritance of an abnormal gene. Additionally, higher rates of thyroid cancer have been found in among people with genetic conditions such as Gardner syndrome, Cowden disease, and familial adenomatous polyposis (FAP). Thyroid cancer is also more likely to occur in people with a history of goiters and benign thyroid nodules.
Gender and Age

Women are about three times as likely to develop thyroid cancer as men. And thyroid cancer is more likely to strike people over 45 years years old. Scientists suspect that too little or too much iodine in the diet could contribute to the development of thyroid cancer.

It’s stress week in Canada

2010-12-05T08:50:00.001-08:00

Actually it’s stress week on Canadian TV. That doesn’t mean network executives sweating over the latest audience ratings.

Stress week is a series of reports on stress and its impact on health and quality of life. Click the screen-shot image on the right to go the video segment from Tuesday on the physical impact of stress. A written summary on the topic, separate from the video content, is posted here.

In that summary, Dr. Maria Shapiro provides detail on stress and immune function:

“It is known that stress has an impact on our immune function. It can decrease our immune system and cause a decrease in what is called our natural killer cells. It also can cause a decrease in our immune peptides. These kinds of changes can explain why you are more likely to get sick when you feel stressed. There is a decrease in IgA- that is an immunoglobulin that fights infection as well. It has been said that there is a two fold increase in upper respiratory tract infections when stress is present.”

This just provides more science-based illustration that chronic stress can really mess up immune system performance, contributing to a host of physical problems. Immune balancing is one way to fight back against stress when it stresses your immune function.

Sports and stress are heating up.

2010-12-05T08:49:00.000-08:00

When historians look back at civilization a thousand years from now, they’ll see that one cultural force dominated

Kill the ref!!

society. It wasn’t music or gardening or art. It was spectator sports. In the era of world-wide recession, fan enthusiasm makes sports recession-proof. The Dallas Cowboys build a $2 billion stadium. College coaches’ salaries make them the highest paid public employees in many states. Public school budgets are in tough shape but sports programs continue to flourish.

Some researcher have conducted studies on fan mental health and stress levels. Soccer (also called football outside of the States) is a good sport to study because fans (a word derived from fanatic) worldwide seem to be equally passionate about soccer, the most followed sport in the world.

One study of German soccer fans produced a lot of interesting findings. Stress from fans’ over-the-top, life-or-death mindset with teams’ wins and losses can lead to cardiac stress, especially when coupled with many fans’ tendency to eat a lot of junk, not get enough sleep and enjoy the drinking life.

An almost humorous, but serious, overview of fans’ mental and emotional life shows a lot of stuff that certainly can up the chronic stress levels.

So as bowl season and conference championship games approach in the next two months, make sure you keep your immune system balanced. Your family’s sports rituals will demand it.

Were you or a loved one waiting in a line last weekend to buy the latest “Call of Duty: Black Ops” computer game?

2010-12-05T08:48:00.001-08:00

If so, I would not be surprised, as this game generated $360 million in sales over the weekend. That’s more than a blockbuster movie opening. I’m not a gamer, but I’ve had a couple experiences observing hardcore gamers. And it is fascinating, even a bit frightening.

One is a college student, a son of family friends of ours who was accepted into a top-flight private college, only to nearly get the boot or lose his financial award package because his World of Warcraft habit kept him away from class too often. Another is a husband and wife we know who spend weekends doing group gaming with other couples. Who takes care of the kids, we don’t know.

I hope that the rise in gaming interest doesn’t portend a rise in addictive gaming behavior, for which there are treatment programs far and wide. But that’s Pollyannish thinking. I’m sure addiction is rising.

As for immune health, the obvious fallout stems from the fact that playing video games on an intense basis (other than the physical Nintendo Wii workout games) means sitting for hours on your sedentary butt, getting little physical activity, probably not eating well and also probably not getting enough sleep. This all can combine for an out-of-balance immune system.

But wait, maybe it’s not all bad. The Brits are launching a study to see if playing video games, at least at a reasonable proportion, might actually improve immune health. What??!!

Another acronym to know in the immune balance story: EDC

2010-12-05T08:47:00.001-08:00

Don’t forget that acronym: EDC. It stands for “endocrine disrupting compound.” A new University of Michigan study suggests that exposure to an EDC substance called triclosan, found in antibacterial soaps and other products like diaper bags and toothpaste, may be linked to higher instances of allergies among young people age 18 and under.

The endocrine system is the hormone production center for the body. Hormones can be a significant modulator of immune cell activity.

The author of the study had this summarizing statement about exposure to triclosan: “The triclosan findings in the younger age groups may support the ‘hygiene hypothesis,’ which maintains living in very clean and hygienic environments may impact our exposure to micro-organisms that are beneficial for development of the immune system,” said Allison Aiello, associate professor at the U-M School of Public Health and principal investigator on the study.

Keep in mind, this study is simply an analysis of data collected from 2003 to 2006. It was not a direct intervention study where participant were given a compound and compared to a placebo group. The evidence for EDCs and immune function is still being debated and far from settled.

Clinical Thyroidologists: What we do for our patients.

2010-12-05T08:44:00.000-08:00

In the last month in cooperation with filmmaker John Lynch, I have produced 5 2 minute videos to explain what a real clinical thyroidologist, who only see patients with thyroid disease or thyroid cancer does. The first one is an introduction to my center, and an example of the careful history and physical examination that still is the key to discovering the cause of the thyroid disease. The second is my clinical thyroid nuclear medicine section to evaluate toxic nodules, Graves disease, and cancer.The video is designed to explain why the thyroid expert is the best person to treat you, not the general nuclear medicine types who spend little time with thyroid patients. I can treat the cancer patients with radio-iodine as an outpatient. The hall mark of my center is the core thyroid lab, with excellent confirmed results for T4,T3,TSH,TPO Antibodies, Thyroglobulin, thyroglobulin antibodies,and Calcitonin. The Ultrasound section is top heavy with state of the art testing and treatment for nodules and cancer.We are one of the few centers to treat thyroid/parathyroid cysts,and cancer lymph nodes with ethanol. The thyroid cytology section is a leader in the field of alerting endocrinologist of the need to quality control the results of thyroid FNA,and surgical pathology results by general pathologists concerning their own private patients before subjecting them to surgery or radiation therapy. The videos are uploaded to my twitter site and blog.
Enjoy,
Dr.G.

Name of Prescription Drug.

2010-07-07T13:04:00.001-07:00

To help make the use of prescription drugs safer and more affordable, our plan is now using a Drug Quantity Management program. That is, for certain medications, you can receive an amount to last you a certain number of days. This gives you the right amount to take the daily dose considered safe and effective, according to the recommendations of the U.S. Food and Drug Administration (FDA). Based on the FDA’s guidelines and other medical information, our plan developed this program together with Express Scripts, the company chosen to manage our prescription drug benefit.

The following limits are based on a 34-day supply, but our benefit may provide a different supply. For instance, you may be able to get a 90-day supply of your medication through mail order service. Your doctor could also request a prior authorization. If this request is approved, a prior authorization would let you receive more than the recommended quantity.

Drug Quantity Limits

for Metavante Technologies, Inc.

Prescription Drug Benefit

Name of Prescription Drug	Maximum Quantity
Actonel 35 mg	5 tablets
Actonel 5 and 30 mg	34 tablets
Actonel 75 mg	2 tablets
Actonel with Calcium tablets	35 Tablets
Actoplus Met 15/500mg and 15/850mg	102 tablets
Actos 15, 30, 45 mg	34 tablets
Advair Diskus 100/50, 250/50, and 500/50 with device	28, 120 blisters
Advair HFA	2 inhalers
Aerobid/Aerobid-M 7 grams	3 inhalers
Aerospan 80mcg 8.9 gram	3 inhalers
Aerospan 80mcg 5.1 gram	1 inhaler
Albuterol generic inhaler	3 inhalers
Allegra 180 mg	34 tablets
Allegra 30, 60mg	68 tablets
Allegra-D 12 hour	68 tablets
Allegra-D 24 hour	34 tablets
Alora	10 patches
Alupent 14 grams	3 inhalers
Ambien 5, 10 mg	34 tablets
Ambien CR 6.25mg and 12.5mg	34 tablets
Amerge 1, 2.5 mg	9 tablets
Anzemet 50, 100 mg	1 tablet
Arava 10 mg, 20 mg	34 tablets
Asmanex 14 inhalation units	1 inhaler
Asmanex 30, 60, 120 inhalation units	2 inhalers
Astelin Nasal Spray (34 ml bottle)	2 bottles
Atrovent HFA 12.9 grams	2 inhalers
Atrovent inhaler 14.7 grams	3 inhalers
Atrovent nasal spray 0.03% (30 grams), generic	2 bottles
Atrovent nasal spray 0.06% (15 grams), generic	2 bottles
Avandamet 1 mg/500 mg, 2/500, 4/500, 2/1000, 4/1000	68 tablets
Avandaryl 4mg/1mg, 4mg/2mg, 4mg/4mg, 8mg/2mg, 8mg/4mg	34 tablets
Avandia 2, 4 mg	68 tablets
Avandia 8 mg	34 tablets
Avonex	4 syringes
Axert 6.25 mg	6 tablets
Axert 12.5 mg	12 tablets
Azithromycin	See Zithromax
Azithromycin 500mg	4 tablets
Azmacort 20 grams	3 inhalers
Beconase AQ 25 grams	2 inhalers
Betaseron	15 vials with prefilled diluent syringe
Boniva 2.5 mg	34 tablets
Boniva 150 mg	1 tablet
Brovana Inhalation Solution (30 vial carton)	3 cartons for a 34-day supply
Butorphanol tartrate Nasal Spray	2 spray bottles
Byetta 1.2 ml (250 mcg/ml)	2 syringes
Byetta 2.4 ml (250 mcg/ml)	2 syringes
Cabergoline 0.5mg	10 tablets
Catapres-TTS Patches	5 patches
Caverject	12 vials, kits, or ampules
Cesamet	30 capsules
Chorionic gonadotropin 10000 units, generic	3 vials
Cialis 5, 10, and 20 mg	6 tablets
Cialis 2.5mg	34 tablets
Clarinex/Clarinex Reditabs 5 mg	34 tablets
Clarinex 2.5mg Reditabs	34 tablets
Clarinex-D 12 hour	68 tablets
Clarinex-D 24 hour	34 tablets
Claritin 10 mg/Claritin Reditabs 10 mg, Claritin 5 mg chewable tablets	34 tablets
Claritin-D 12 Hour	68 tablets
Claritin-D 24 Hour	34 tablets
Climara, Climara Pro	5 patches
Combivent 14.7 grams	3 inhalers
Copaxone 20 mg kit	1 kit (30 prefilled syringes)
Cordran Tape	2 rolls of tape
Crestor 40 mg	34 tablets
Depo-Provera Contraceptive Injection 150 mg/mL	1 vial/syringe
Depo-Sub Q Provera 104	1 syringe
Diflucan 150 mg	2 tablets
Ditropan XL 5 mg	34 tablets
Divigel 0.25, 0.5, and 1 grams	34 packets
Dostinex 0.5 mg	10 tablets
Duetact 30/2mg and 30/4mg	34 tablets
Duoneb 3 ml vial	205 vials (package size 3)
Edex	12 vials or kits
Elestrin gel pump	1 pump
Emend 125 mg	1 capsule
Emend 40mg capsule	1 capsule
Emend 80 mg	2 capsules
Emend Trifold Pack (one 125 mg and two 80 mg capsules)	1 pack (package size 3)
Enbrel 25mg vials	10 vials
Enbrel 25 mg syringes	10 syringes
Enbrel 50mg syringe/auto injectors	5 syringes/auto injectors
EpiPen, EpiPen Jr.	3 units or 2 twin packs
Esclim	10 patches
Estraderm	10 patches
Estradiol transdermal patch	5 patches
Estrasorb	68 packets
Estrogel .06% 50gm	2 pump bottles
Factive 320mg	7 tablets
Famvir 125 mg	21 tablets
Famvir 250 mg	68 tablets
Famvir 500 mg	21 tablets
Fexofenadine	See Allegra
Flonase 16 grams	2 bottles
Flovent 50mcg Diskus	2 inhalers
Flovent HFA 44mcg	2 inhalers
Flovent HFA 110mcg	1 inhaler
Flovent HFA 220mcg	3 inhalers
Fluconazole 150mg	2 tablets
Flunisolide 0.025%	3 inhalers/bottles
Fluticasone Nasal Spray	2 sprays
Foradil Aerolizer & 12 capsules in blisters	1 package (package size 12) 12 caps
Foradil Aerolizer & 60 capsules in blisters	2 packages (package size 60) 120 caps
Fosamax 35 and 70 mg	5 tablets
Fosamax 5, 10, and 40 mg	34 tablets
Fosamax 70 mg/75 mL oral solution	5 bottles
Fosamax Plus D 70 mg/2800 IU, 70mg/5600 IU	5 tablets
Frova 2.5 mg	9 tablets
Humira 40mg syringe/pen	3 syringes/pen
Humira Crohn’s Starter Pack	3 syringes
IB Stat oral spray 30 mL	14 bottles
Imitrex Injection (syringes/cartridges)	1 kit (2 syringes)
Imitrex 4mg injection (syringes/cartridges)	1 kit (2 syringes)
Imitrex Injection (vials)	2 vials
Imitrex Nasal Spray 5, 20 mg	6 nasal spray devices
Imitrex tablets 25, 50, and 100 mg	9 tablets
Intal Inhaler 112	2 inhalers
Intal Inhaler 200	2 inhalers
Itraconazole 100mg	34 capsules
Janumet 50/500 mg, 50/1000 mg	68 tablets
Januvia 25mg, 50mg, 100mg	34 tablets
Ketoralac 10 mg	20 tablets
Kytril 1 mg	2 tablets
Kytril solution 2 mg/10 mL	1 bottle
Levitra 2.5, 5, 10, and 20 mg	6 tablets
Lioresal Inthrathecal Refill Kit 1 ampule 10 mg/20 ml 2 ampules 10 mg/5 ml 1 ampule 40 mg/20 ml	1 kit
Lunesta 1mg, 2mg, 3mg	34 tablets
Maxair Autohaler 14 grams	2 inhalers
Maxalt and Maxalt-MLT 5, 10 mg	12 tablets
Menostar	5 patches
Miconazole	See Monistat
Migranal 4 mg/ml	8 spray devices
Mobic 7.5 mg	34 tablets
Monistat 1 pre-filled	1 box
Monistat 3 combination pack 200 mg & equivalent	1 box
Monistat 3 suppositories 200 mg & equivalent	3 (1 box)
Monistat 7 combination pack & equivalent	1 box (7 suppositories, 9 gram cream)
Monistat 7 cream and equivalent	45 grams (1 tube)
Monistat 7 cream pre-filled applicators	7 applicators
Monistat 7 suppositories 100 mg & equivalent	7 suppositories (1 box)
Monistat Dual Pak (1200 mg vaginal insert, 9 gram 2% cream)	1 (1 box)
Monistat Dual-Pak (three 200 mg vaginal supp, 15 gram 2% cream)	1 (1 box)
Muse	12 urethral suppositories
Nasacort 10 gram	3 inhalers
Nasacort AQ 16.5 gram	2 bottles
Nasarel 0.025% 25 mL	3 bottles
Nasonex 50 mcg nasal spray 17 gram	2 bottles
NebuPent 300 mg/container	1 container (inhaler)
Neumega	21 vials
Newtek disposable blood glucose meter	2 meters
Nexium 20 mg	34 capsules
Nexium 20 mg packets	34 packets
Noverel 10,000 unit	3 vials
Omeprazole 10 mg	34 capsules
Ondansetron 24 mg	1 tablet
Ondansetron, Ondansetron ODT 4 and 8 mg	12 tablets
Ondansetron solution 4 mg/5 mL	3 - 50 mL bottles
Oxybutynin XL 5 mg	34 tablets
PEG Intron Pens/Kit (containing 1 vial each) 50 mcg, 80 mcg, 120 mcg, 150 mcg	5 pens/vials
Pegasys 180 mcg	5 vials (package size 1)
Pegasys 180 mcg Convenience Pack ( 4 vials)	1 box (package size 1)
Pegasys 180 mcg Convenience Pack (4 prefilled syringes)	1 box (package size 1)
Perforomist Inhalation Solution	2 cartons (120 vials)
Plan B	2 tablets
Pregnyl 10,000 unit	3 vials
Prevacid 15 mg, Prevacid SoluTab	34 capsules or tablets
Preven Contraceptive Kit	1 kit
Prevpak patient pack	14 units (1 package)
Prilosec 10 mg	34 capsules
Prilosec 20 mg (Brand)	34 capsules
Proair HFA	3 inhalers
Protonix 20 mg	34 tablets
Proventil Inhaler 17 gram	3 inhalers
Proventil HFA 6.7 gram	3 inhalers
Pulmicort Flexhaler 90 mcg	2 inhalers
Pulmicort Flexhaler 180 mcg	3 inhalers
Pulmicort Respules 0.25 mg/2 mL and 0.5 mg/2 mL	70 ampules
Pulmicort Respules 1 mg/2 mL	35 ampules
Pulmicort Turbuhaler	2 inhalers
Qvar 40, 80mcg (7.3 grams)	3 inhalers
Rebetron Combination, Rebetron 1200, 1000, and 600 Therapy Pak	2 packages
Rebif 22 mcg and 44 mcg	15 syringes
Rebif Titration Pack 4.2ml	1 package
Regranex 0.01%gel 2, 7.5, and 15 gm	1 tube
Relenza 5 mg/blister with inhalation device	20 blisters
Relpax 20 mg and 40 mg	6 tablets
Restasis 0.05%	68 vials
Revatio 20mg	102 tablets
Rhinocort Aqua 32 mcg (120 inhalations) 8.4ml bottle	3 bottles
Rozerem 8mg	34 tablets
Serevent Diskus 28 blisters	1 package
Serevent Diskus 60 blisters	2 packages
Sonata 10 mg	68 capsules
Sonata 5 mg	34 capsules
Spiriva Handihaler 6 capsules (1 blister card) with inhaler device	1 package
Spiriva Handihaler 30 capsules (5 blister cards) with inhaler device	2 packages
Spiriva Handihaler 90 capsules (6 blister cards) with inhaler device	1 package
Sporanox 100 mg	34 capsules
Stadol Nasal Spray 2.5 mL	2 spray bottles
Suboxone 2/.0.5 mg	102 tablets
Suboxone 8/2 mg	102 tablets
Symbicort 80/4.5, 160/4.5 Inhaler	2 inhaler
Symlin 0.6mg/ml	7 vials
Tamiflu 30 mg	20 capsules
Tamiflu 45 mg	10 capsules
Tamiflu 75 mg	10 capsules
Tamiflu for oral suspension, 25 mL	3 bottles
Terazol 3	3 (1 box)
Terazol 3 Cream 0.8%	1 tube (of the 20 gram)
Terazol 7 Cream 0.4%	1 tube (of the 45 gram)
Terconazole	See Terazol or Zazole
Tilade 16.2 grams	3 inhalers
TOBI 300 mg	56 ampules
Toradol 10 mg	20 tablets
Twinject 0.3mg or 0.15mg Auto-Injector	3 units or 2 twin packs
Valtrex 1 gram	34 caplets (tablets)
Valtrex 500 mg	34 caplets (tablets)
Ventolin HFA 90 mcg (18 grams)	3 inhalers
Veramyst Nasal Spray	2 bottles
Viagra 25 mg, 50 mg, and 100 mg	6 tablets
Vivelle	10 patches
Vivelle-Dot	10 patches
Xopenex HFA	3 canisters
Xyzal	34 tablets
Zazole Cream 0.4%	1 pack (45 gram)
Zazole Cream 0.8%	1 pack (20 gram)
Zazole 80mg Vaginal Supp	3 (1 box)
Zegerid 20 mg	34 tablets
Zithromax for oral suspension 100 mg/5 mL, 15 ml bottle	2 bottles
Zithromax for oral suspension 200 mg/5 mL, 15 and 22.5 ml bottle	3 bottles
Zithromax for oral suspension 200 mg/5 mL, 30 ml bottle	3 bottles
Zithromax tablet or capsule, 250 mg	8 tablets/capsules
Zithromax tablet, 500 mg	4 tablets
Zmax 60 ml	1 bottle
Zofran 24 mg	1 tablet
Zofran, Zofran ODT 4 and 8 mg	12 tablets
Zofran solution 4 mg/5 mL	3 - 50 mL bottles
Zolpidem tartrate 5 and 10 mg	34 tablets
Zomig/Zomig-ZMT 5 mg	6 tablets
Zomig Nasal Spray 5 mg	6 nasal spray devices
Zomig/Zomig-ZMT 2.5 mg	6 tablets
Zyrtec, Zyrtec chewable 5 and 10 mg	34 tablets
Zyrtec-D 12 Hour	68 tablets

PATIENT INFORMATION LEAFLET - BREAST DISORDERS

2010-07-07T12:58:00.001-07:00

PATIENT INFORMATION LEAFLET - BREAST DISORDERS

Nine out of ten breast problems are not related to cancer. Breast problems are very common, two out of three women will have breast pain at some time in their lives. However, breast cancer is the most common cancer in women and approximately 1 in 10 women will be affected at some time in their lives. There are however, many other disorders of the breast which should always be checked by a doctor to rule out the possibility of any malignancy.
Breast pain can be either cyclical, that is related to hormonal changes and occurring premenstrually or non-cyclical and present at any time of the month.
Breast lumps should always be checked and may be cysts, an abscess, general lumpiness of the breasts or a single lump.
Nipple discharge may occur and can be due to several factors.

BREAST PAIN

What causes breast pain?

Most breast pain is not a sign of cancer and can be treated. Cyclical breast pain is linked to a woman's monthly period. Most women experience tenderness in the breasts a few days before a period but in some women this can be more severe and the breasts may also feel generally lumpy at this time.

What treatment is available?

A well-fitting, supportive bra should help to relieve the pain. There is evidence that eating a high level of fat in the diet can increase breast pain and so reducing fat in the diet may be of use. (Cut down on butter, cream, hard cheese and trim the fat off meat).
There is treatment which a doctor can prescribe for cyclical pain. Gamolenic acid (GLA) is based on evening primrose and starflower oil. It may be called Efamast and will be given daily for three months. It is non-hormonal and raises the level of polyunsaturated fatty acids in the body. GLA purchased in shops and not on prescription may not contain sufficient quantities to relieve the problem.
There are also hormonal tablets which can be given if the GLA does not improve the pain. Danazol, which counteracts the body's own hormones may be given in a high dose for a month and then a decreased dose thereafter. Pregnancy should be avoided whilst taking these tablets. It may be called Danol.
A dopamine agonist in the form of bromocriptine may be given. It reduces the naturally occurring hormone7 prolactin which stimulates the breast. It may be called Dostinex or Parlodel. The dose may be increased slowly and continued for six months.

In non-cyclical breast pain, non steroidal anti-inflammatory painkillers (NSAIDs) may be of use. These could be ibuprofen or aspirin. Paracetamol is another simple painkiller which may help. Treatment may be given for six weeks. If the pain is in a specific localised area, a local anaesthetic may be injected with a steroid to relieve the pain.
Pain with a lump in the breast is unlikely to be cancer and will usually be a cyst.

BREAST LUMPS

What causes breast lumps?

Nine out of ten women have breast lumps which are not cancer. If there is a single lump referral to a breast specialist will usually be made. The lump may be a fibroadenoma or a cyst. A fibroadenoma is caused when the fibrous tissue of the breast becomes overdeveloped, it is harmless and some women may have a few of these lumps. They do not require treatment but can be removed if they are causing anxiety.
Cysts tend to be more common in women over 40. They contain fluid and appear suddenly. There may be pain and several may occur at the same time.
What treatment is available?
The fluid is drawn off from the cyst with a fine needle which relieves the pain and the cyst usually disappears. Cysts may be recurrent. Further investigations like a mammogram or ultrasound may be ordered.

NIPPLE DISCHARGE Nipple discharge is common. There are varying reasons for discharge and although a blood stained discharge could indicate a serious disease, mostly the reasons are not serious. Following breast feeding, many women may continue to have a slight discharge for many months. Discharge can occur as a side-effect of some drugs, such as tranquillisers or tablets to lower blood pressure. A disturbance in hormone levels, such as a pituitary disorder may also cause a discharge.

What treatment is available?

All nipple discharge should be checked by a doctor and referral to a specialist may be necessary in line with our guidelines. If it is caused by a side-effect of a drug, the tablet may be stopped or changed. A blood test may show if it is due to a hormonal disorder.

RED Specialist prescribing only,AMBER Prescribe under shared-care protocol

2010-07-07T12:52:00.001-07:00

Mid-Essex Area ‘Traffic Lights’

Specialist prescribing only for the condition stated-usually secondary care but could be accredited GPwSI when working within an accredited specialist service.

Amber =Prescribed under shared-care protocol (Local Enhanced Service) for the condition stated-drug requiring additional biochemical monitoring on a level 1, 2 or 3 basis as per Local Enhanced Service.

Yellow = Medicines to be initiated by an accredited specialist prescriber and recommended to GP for continued prescribing after a defined period of timen, where n= minimum number of months for specialist prescribing. No additional blood monitoring is required but in some cases other assessment will be necessary as set out in defined guidance.

Purple = Drugs not recommended for prescribing within Mid-Essex

All other Formulary drugs not appearing on this list are considered to be ‘Green’ and suitable for prescribing in primary care. GPs and specialists should consult their Pharmacist prescribing advisor before prescribing any non-formulary drug for the first time. This list will be revised on a regular basis. Drugs may change category over time and all prescribers will be notified of any changes.

RED Specialist prescribing only Usually secondary/tertiary care but could be accredited GPwSI
Acitretin	Psoriasis
Adalimumab	Rheumatoid Arthritis
Alitretinoin	Severe chronic hand eczema
Anagrelide	Reduction of elevated platelet counts
Apriclonidine eye drops	Intra ocular pressure
Becaplermin Gel	Adjunct treatment of full-thickness, neuropathic, diabetic ulcers
Benperidol	Antipsychotic – sexual disinhibition.
Beta interferon 1-a (Avonex, Rebif)	Relapsing Remitting MS
Beta interferon 1b (Betaferon)	Relapsing Remitting MS Secondary Progressive MS
Bevacizumab	Renal cell carcinoma
Botulinum toxin (Botox, Dysport)	All indications
Calcium resonium	Hyperkalaemia
Capecitabine	Colorectal and breast cancer
Cilostazol	Intermittent claudication
Cinacalcet	Secondary hyperparathyroidism in end-stage renal disease on dialysis
Darbepoetin	Anaemia associated with chronic renal failure and non-myeloid malignancies
Deferasirox	Iron overload
Deferiprone	Iron overload
Desferrioxamine	Iron overload
Disodium edetate eye drops	Chelating agent
Entecavir	Chronic Hepatits B infection
Erythropoietin	Anaemia associated with erythropoietin deficiency in renal failure
Estramustine	Prostate cancer
Etanercept	Rheumatoid arthritis, psoriatic arthritis, psoriasis
Fludarabine	Chronic lymphocytic leukaemia
Ganciclovir (Cymevene)	Life and sight threatening cytomegalovirus infections
Glycopyrrolate	Hyperhidrosis
Hyaluronic acid & derivatives (e.g.Durolane)	Osteoarthritis of the knee
Imatinib	Chronic myloid leukaemias and gastro intestinal stroma tumours
Imiquimod	External genital and perianal warts
Indinavir	HIV infection
Infliximab	Crohn’s disease, rheumatology
Insulin glulisine	Diabetes mellitus
Interferon Alfa (Intron A, Viraferon, Viraferon Peg PegIntron, Roferon A)	Hepatitis C
Interferon Alfa-2b (Intron A)	Multiple myeloma/Renal Cancer
Iodine (aqueous oral solution) (Lugol’s Iodine)	Thyrotoxicosis
Isotretinoin	Acne
Lamivudine	HIV infection, Hep B infection
Methoxypsoralen	PUVA
Nimodipine	Subarachnoid haemorrhage
Olanzapine injection	Psychiatric use only. Control of agitation and disturbed behaviour
Omalizumab	Severe persistent allergic asthma
Palivizumab	Prevention of serious lower respiratory infection caused by RSV
Paricalcitol	Secondary hyperparathyroidism
Phenoxybenzamine	Phaeochromocytoma
Pilocarpine tablets	Xerostomia
Quinagolide	Hyperprolactinaemia
Ribavirin	Severe respiratory sybcytial virus bronchiolitis
Ritonavir	HIV infection
Rivaroxaban	Prevention of venous thromboembolism after total hip or knee replacement in adults
Saquinavir	HIV infection
Sertindole	Schizophrenia
Sodium Picosulphate	Bowel cleansing
Sorafenib	Renal cell carcinoma
Sucralfate	Benign gastric & duodenal ulceration & chronic gastritis.
Sunitinib	Renal cell carcinoma
Tegafur	Colorectal cancer
Temozolomide	Glioma – 2nd line
Teriparatide	Osteoporosis
Vinorelbine	Lung and breast cancer
Zolendronic acid (Aclasta)	Pagets disease Treatment of postmenopausal osteoporosis
All drugs for pulmonary hypertension	Tertiary Care and specialized packages
Enzyme replacement therapy	Tertiary Care and specialized packages
Total Parenteral Nutrition (TPN)	Tertiary and specialized packages. Agreed packages of home care
Immunoglobulins	Primary Immunodeficiency
AMBER Prescribe under shared-care protocol Additional biochemical monitoring required on a Level 1,2 or 3 basis as per local enhanced service
Azathioprine	Rheumatology Inflammatory bowel disease
Ciclosporin (to be prescribed by brand)	Transplantation
Clozapine (Clozaril)	Schizophrenia
Gold injection (sodium aurothiomalate)	Rheumatology
Gold oral (auranofin)	Rheumatology
Leflunomide	Rheumatology
Methotrexate Oral	Rheumatology
Methotrexate injection	Rheumatology
Mycophenolate Mofetil	Immunosuppressants
Penicillamine	Rheumatology
Sirolimus	Transplantation
Sulfasalazine	Rheumatology
Tacrolimus (to be prescribed by brand)	Transplantation
YELLOW Initiated by accredited specialist prescribers then recommended in writing to GP. To be prescribed by specialist for a defined period of time before GP is asked to prescribe. Additional biochemical monitoring not required however other assessment may be necessary. Many of these patients will receive continuing support from specialist. GP care is within the GMS contract.
Acamprosate	Alcohol dependence (1 year course). Stop if patient starts drinking again
Anastrozole	Breast Cancer
Antipsychotics (depot)	Schizophrenia & psychosis
Apomorphine	Parkinson's disease
Aripiprazole (Abilify)	Schizophrenia
Atomoxetine3 (Strattera)	Treatment of ADHD
Bicalutamide	Advanced prostate cancer
Bimatoprost	Intraocular pressure
Bromocriptine	Advanced Parkinson’s disease/Hyperprolactinaemia
Brompheniramine	Chronic intractable cough (unlicensed – prescribe as per pathway)
Cabergoline (Cabaser)	Advanced Parkinson's disease
Cabergoline (Dostinex)	Hyperprolactinaemia
Carbocisteine	Reduction of sputum viscosity
Carmellose sodium (Optive, Celluvisc 0.5%)	Dry Eye Conditions
Chloroquine sulphate	Rheumatology
Chloroquine phosphate	Rheumatology
Clobazam	Epilepsy
Colestyramine	All indications
Cyproterone acetate	Prostate cancer
Dermovate 1:5 & 1:10	Eczema/psoriasis
Dexamphetamine 5mg3	Narcolepsy. ADHD with continuing care guidance.
Diltiazem (2% cream)	Anal fissure (unlicensed – prescribe as per pathway)
Donepezil3	Alzheimer’s disease with continuing care guidance
Dornase Alfa	Cystic fibrosis
Doxepin	All indications
Duloxetine (Cymbalta)	3rd line alternative for depression
Entacapone	Parkinson’s disease
Eplerenone	Adjunct in stable patients with LVD with heart failure, following MI
Erdosteine	Acute exacerbations of chronic bronchitis
Exemestane	Advanced breast cancer
Exenatide	Type 2 Diabetes
Finasteride	Benign prostatic hyperplasia
Fludrocortisone	Mineralocorticoid replacement
Flutamide	Advanced prostate cancer
Fluvoxamine	Depression
Gabapentin (prescribe as capsules)	Neuropathic pain, epilepsy
Galantamine3	Alzheimer’s disease with continuing care guidance.
Goserelin	Prostate cancer
Hydroxycarbamide	Chronic myeloid leukaemia
Hydroxychloroquine	Rheumatology
Hypromellose preservative free eye drops	Eye lubrication
Ibandronic acid (Bondronat)	Reduction of bone damage in bone metastases in breast cancer
Ivabradine	Stable angina pectoris when beta blockers contra-indicated as per local guideline
Lacosamide	Epilepsy
Lamotrigine	Epilepsy
Lanreotide LA (Somatuline LA and Autogel)	Symptoms associated with carcinoid tumours
Lanthanum	Hyperphosphataemia in patients on haemodialysis or CAPD
Letrozole	Advanced breast cancer
Leuprorelin	Advanced prostate cancer
Levetiracetam	Adjunctive treatment of partial seizures
Levobunolol	Intraocular pressure
Lidocaine plasters	Post herpetic neuralgia
Lithium (Specify brand)	Mania. Adjunct in depression. Priadel is brand of choice.
Low molecular weight heparin (Clexane)	DVT
Megesterol Acetate	Endometrial cancer
Melatonin (Circadin)	Sleep disorders in children strictly as per continuing care guidance
Methylphenidate3 (Specify brand)	ADHD with continuing care guidance
Minims eye drops Preservative free	Allergy to preservatives in eye drops
Moclobemide	Depressive illness (Beta MAOI)
Modafinil	Daytime sleepiness (Narcolepsy)
Nandrolone	Anabolic steroid
Nicorandil	Angina
Octreotide	Symptoms associated with carcinoid tumours
Omacor (Omega-3-acid ethyl esters)	Hypertriglyceridaemia (3rd line) TG > 10
Pancreatin (Creon, Pancrex, Pancrex V)	Intestinal secretions
Paroxetine	Depression
Pergolide	Parkinson’s Disease
Pericyazine	Schizophrenia
Phenelzine	Depressive illness (MAOI)
Phenobarbital	Epilepsy
Phenytoin (Epanutin CAPSULES)	Epilepsy
Pilocarpine eye drops	Miotic
Pimecrolimus cream	Acute treatment of mild to moderate atopic eczema
Piracetam	Epilepsy
Pramipexole	Parkinson’s disease
Prasugrel (consultant cardiologist initiation only)	Stent thrombosis in patients already receiving clopidogrel
Pregabalin	Neuropathic pain
Pyridostigmine	Myasthenia gravis
Riluzole	To extend life or the time to mechanical ventilation in amyotrophic lateral sclerosis
Rivastigmine3	Alzheimer’s disease with continuing care guidance
Risperidone long acting IM injection	Schizophrenia with continuing care guidance
Ropinirole	Parkinson’s disease
Rotigotine	Parkinson’s disease
Selegiline	Central nervous system
Sevelamer	Hyperphosphataemia in patients on haemodialysis
Sodium Clodronate (Bonefos)	Osteolytic lesions, hypercalcaemia and bone pain associated with skeletal metastases in patients with breast cancer and multiple myeloma
Somatropin (children)	In line with NICE guidance
Somatropin (adults)	In line with NICE guidance
Stalevo (Levodopa, carbidopa, entacapone)	Parkinson’s disease
Tacrolimus ointment	Moderate to severe eczema unresponsive to conventional therapy
Tiagabine	Adjunctive treatment for partial seizures with or without secondary generalisation
Timolol eye drops	Intraocular pressure
Tizanidine	Spasticity associated with MS or spinal cord injury
Tobramcyin (TOBI)	Cystic fibrosis
Topiramate	Migraine, epilepsy
Travoprost	Intra ocular pressure
Tretinoin	Acne, hyperpigmentation
Travoprost	Glaucoma
Ursodeoxycholic Acid (Ursofalk)	Primary biliary cirrhosis
Valproate semisodium (Depakote)	Bipolar disorder
Valproate & salts (Epilim, Epilim Chrono, Epicenta and others)	Epilepsy (GP may initiate at point of referral)
Venlafaxine3 in doses of 300mg and above	Depression with continuing care guidance

GREEN All other FORMULARY drugs are freely available

to be prescribed.

(Please consult with prescribing advisor before prescribing a

non-formulary drug.)

Substance Misuse – prescribe under shared care protocol
Buprenorphine	Opioid dependence
Chlordiazepoxide	Alcohol withdrawal
Disulfiram	Alcohol withdrawal usually up to a year
Lofexidine	Management of symptoms of opioid withdrawal
Methadone oral solution 1mg/1ml	Opioid dependence
Naltrexone	Adjunct to prevent relapse in previous opioid-dependent patients

Medicines not recommended for prescribing within Mid Essex

Zotepine	Schizophrenia
Memantine	Alzheimer’s disease
Omega-3 acid ethyl esters	Secondary prevention of MI
Glucosamine	Osteoarthritis

New Horizons in Thyroid Health: Recent Research Findings That Could Expand Your Thyroid Treatment Options

2010-06-27T07:19:00.000-07:00

For centuries, the role of the thyroid was not fully understood. In fact, it was not until the last several decades that researchers began to grasp the full significance of the thyroid and the scope of its impact on overall health and well-being.Although this recognition was a long time coming, the renewed focus on thyroid health in recent decades has opened up the floodgates of research and experimental studies. Today, potentially important findings pertaining to thyroid health are being announced on an ongoing basis.

Indeed, the fast pace of advancement in the field can make it difficult for patients to keep pace. But in order to be an effective advocate for yourself or the thyroid patient in your life, it’s important to try to stay on top of the latest findings in order to ensure that you are receiving the best treatment possible for your particular disorder.

Today, we’ll take a look at some of the most significant research findings that have been recently announced by scientists investigating various aspects of thyroid health.
Prematurity and Small Body Size in Childhood May Predict Hypothyroidism Risk

Researchers in Finland analyzed the birth records and childhood growth charts of adult women who developed hypothyroidism as adults. It was found that those who had been born prematurely or who were of below-average size during childhood were at greater risk of suddenly developing hypothyroidism as adults. The researchers point out that this information could be used to screen those at greatest risk for the disease.
Hypothyroidism Can Have Grave Implications for Women’s Reproductive Health

A team of Czechoslovakian researchers analyzed the reproductive and gynecological effects of slow thyroid function. According to their findings, the impacts of hypothyroidism are significant, perhaps even more widespread than previously suspected. They determined that as many as one-quarter of all cases of infertility may be related to thyroid problems. In addition, the researchers estimated that 15% of menstrual abnormalities could have their roots in thyroid disorders.
Occupational Exposure to Radiation Increases Workers’ Thyroid Risks

Several recent studies have sought to identify the possible environmental causes of thyroid disorders. One study found that workers in nuclear power plants were at particularly high risk for developing thyroid disorders. The most pronounced risk was in elevation of serum thyrotropin (TSH) levels. The scientists recommended more research on the environmental and occupational factors that could impact thyroid health.
Exposure to Tobacco Smoke May Pose a Risk for Thyroid Health

It has long been known that tobacco use can impact thyroid function, but a team of Greek researchers recently discovered that exposure to second-hand smoke may also have a deleterious effect on thyroid health. After a group of healthy women with normal thyroid function were exposed to several hours of second-hand smoke, it was found that all of their measurable thyroid functions had increased significantly. The researchers recommend that this environmental factor should be considered in cases of hyperthyroidism and related disorders.
Hypothyroidism During and After Pregnancy

One of the most significant findings in recent years is the degree to which hypothyroidism occurs in women who are pregnant or have recently given birth. Although this risk has long been known, studies conducted in the last several years have indicated that pregnancy-related thyroid disorders may be far more common than previously thought. A team of English researchers found that current testing methods drastically underestimated the hypothyroid risks of pregnancy; as many as 33% of pregnant and postpartum women with thyroid problems were not identified using standard diagnosis techniques.
Hyperthyroidism Linked to Hypertension in Some Patients

An Australian research team conducted a large-scale community study to determine the nature of the relationship between thyroid disorders and elevated blood pressure. Although no link was found between hypothyroidism and hypertension, it was found that people with heightened thyroid function were more likely to have high blood pressure. The researchers suggested that blood pressure may be used as a preliminary screening tool for detecting hyperthyroidism.
Outpatient Thyroid Surgery Safe for Most Patients

A team of researchers in Augusta, GA found that many of the most common types of thyroid surgery could be conducted on an outpatient basis. In a longitudinal analysis of post-surgery outcomes, they found that the recovery and safety of those released from the hospital immediately after surgery equaled or even exceeded that of patients who were admitted for an overnight stay. According to the researchers, this finding could significantly diminish the cost of thyroid surgery for many patients, with average savings estimated to be $2000 or more in most areas of the United States.
Staying Informed Can Help You Stay Healthy

Although your physician bears the primary responsibility of staying abreast of recent research developments that might impact your treatment, it can’t hurt to keep yourself informed, as well. Make a habit of browsing thyroid research sites to find out about the latest findings. For a targeted search, you can set up a Google alert that will automatically inform you of news pertaining to your specific disorder. Also, watch this space for future updates on the latest in thyroid health research.

Prescription Drug Interactions That Could Hurt Your Thyroid Health

2010-06-27T07:15:00.001-07:00

Although thyroid disorders are serious health problems, most of the symptoms of these disorders can be managed with strict adherence to a prescription treatment regimen. In fact, most thyroid patients who take pains to stick closely to their prescribed drug regimen report very few ongoing health problems, high quality of life, and a strong sense of overall well-being.
Understandably, maintaining strict discipline in your daily dosage is the cardinal rule for thyroid patients. If you start to experience troubling symptoms, the first thing your doctor will probably check is your adherence to your prescribed treatment plan and whether the dosages of medication that you've been prescribed are sufficient to treat your disorder.

Many thyroid patients go to great lengths to ensure as much consistency as possible in their medication routine. Pill boxes, daily alarms, and even e-mailed reminders are just a few of the techniques discussed among the participants in online thyroid disorder communities and support groups.

But recent research has suggested that the effectiveness of your thyroid medication could be thwarted by unexpected forces -- namely, other variables in your environment. Even with perfect adherence to your prescription drug regimen, you may not be getting the full benefits of your thyroid medication if another variable is interfering in the absorption of the drugs. This week, we'll take a look at the results of three recent studies that have pointed out possible weaknesses in popular thyroid medications.
Chromium Picolinate May Reduce Absorption of Thyroid Drug Levothyroxine

Weight struggles are an all-too-familiar battle for many thyroid patients, particularly those diagnosed with hypothyroidism or other disorders that result in underperforming thyroid glands. In their quest to regain or maintain a healthy weight, many thyroid patients have begun taking vitamins, supplements, and other products marketed to dieters.

However, a recent study indicated that one popular weight loss supplement may limit the effectiveness of levothyroxine, one of the most commonly prescribed thyroid mediations. The study, which was conducted by a team of researchers at the Stony Brook University School of Medicine in New York, focused on the effect of the mineral chromium picolinate, which is an ingredient in many of the most popular weight-loss formulas.

It was found that study participants who took both chromium picolinate and levothyroxine simultaneously showed substantially reduced absorption of the levothyroxine. However, this effect was eliminated if the two pills were taken at least two to three hours apart. As a result, the researchers suggested that thyroid patients who are taking both medications should consult with their physicians and consider staggering their doses of chromium picolinate and levothyroxine.
Widely Used Kidney Medication May Interfere With Levothyroxine Uptake

In another study with important implications for thyroid patients who rely on levothyroxine, researchers at the University of Tulane in New Orleans found that the effectiveness of this popular thyroid medication may be reduced if it is taken along with a prescription drug commonly used in the treatment of kidney disease.

The drug, sevelamer hydrochloride, which is sold under the proprietary name Renegal, is used to help regulate phosphorus in patients with chronic kidney disease. The study found that when levothyroxine and sevelamer hydrochloride are taken simultaneously, the uptake of levothyroxine is often reduced significantly. However, preliminary results indicate that this effect may be eliminated if consumption of the two drugs is spaced over a period of several hours.
Study Finds that Summer Heat, High-Temperature Storage May Hinder Effectiveness of Thyroid Drugs

Even if you've followed your doctor's dosage instructions to the letter, you still may not be getting the full benefit of your prescription thyroid medications. According to a recent study, exposure to hot temperatures may eradicate some of the potency of the active ingredients in several common thyroid drugs.

According to the researchers, this problem may be particularly widespread during the scorching months of June, July, and August. Even in regions that don't reach extreme highs during the summertime, prescription medications may still be impacted. It was found that several commonly prescribed drugs begin to degrade at temperatures over 86 degrees Fahrenheit. If one of your prescriptions is particularly sensitive to heat, it may be advisable to store it in the refrigerator or another cool, dry environment.

What is a Healthy Thyroid?

2010-06-27T07:13:00.000-07:00

The most common diagnostic test used to measure thyroid health is a TSH test, which stands for thyroid stimulating hormone. When a TSH test is conducted the results are measured against a benchmark which standardizes the norm for the levels of this hormone. The good news is that a TSH test is an easy test to conduct and receive. It is a simple blood test that is can be administered in the privacy of a doctor's office. The bad news is that there are disagreements in the medical community as to what the right levels are. There is a growing community of physicians who surmise that a TSH level of .5 ranging to 5.0 of thyroid hormone is appropriate in the blood. On the other side of the spectrum is a group of physicians who argue that a level of .3 to nearly 3.0 is a more generally appropriate range.

Maintaining a Healthy Thyroid

The rise of the industrial age and the mass production of food has dramatically changed the quality of food that people consume. Many studies confirm that foods which are mass produced can be harmful to thyroid health. A few products which cause acute sensitivity in the thyroid are refined sugars, artificial sweeteners, refined grains and fat metabolism. Distinct fats are exceedingly eventful in all hormonal production because all hormones are created from fats. Trans fats are destructive to the thyroid metabolism because of the interference they create with cellular membrane capacity.
What is Recommended for Thyroid Health?

Researchers have distinguished certain items that help to maintain good thyroid function by preventing excessive thyroid aging, which can cause the thyroid to become dysfunctional in relation to the other organs within the body. The most important item listed by researchers for thyroid health is a well-balanced diet. Although the benefits of organic foods have long been probed for several years, the importance of organic foods have recently been emphasized as a means of maintaining a healthy thyroid. Overuse of chemicals in our food can lead to multiple nutritional side effects.

Scientists also stress the importance of reducing or eliminating the intake of refined or white sugar in the diet as it can cause nutritional imbalances such as insufficient levels of vitamin B in the diet. White flour is a common food item that has little nutritional value and empty calories and should be avoided if thyroid health is a nutritional goal.

Fats and oils which are used almost daily in the preparation of commercially prepared foods can be harmful to thyroid health. A leading physiologist in the study of progesterone and hormones, Ray Peat Ph.D., stated that the sudden influx of polyunsaturated oils into foods after World War II has resulted in many changes in hormones.

Polyunsaturated oils have affected the thyroid gland in that they interfere with its function. These oils are detrimental to hormone secretion, movement within the circulatory system, and the reaction of tissues to hormones. In a scenario in which the thyroid hormone is insufficient, the body is not able to create protective hormones, such as progesterone and pregnenolone, which can result in interference of healthy function of the thyroid. A healthy alternative for cooking is to substitute coconut oils in one's diet, instead of polyunsaturated oils.
Get a Professional Opinion

A consultation with an experienced thyroidologist or an endocrinologist is especially helpful if thyroid health is an issue or concern. Although new research findings represent important strides in thyroid health, much more work will be necessary to pinpoint what exactly is needed for a healthy thyroid and your physician can best determine your needs after a complete examination.

How to Take Medicine for Thyroid

2010-06-27T07:04:00.000-07:00

Those who do not have a strong understanding of thyroid treatments may not be aware of the fact that the manner in which thyroid medication should be taken is important. Most physicians agree that the medicines need to be taken in a certain manner to obtain best results.

Some believe that the manner in which the medication is ingested can actually change the overall effect of the drug. Following the recommended method can surprisingly increase the overall benefits that can be derived from the thyroid treatment that has been opted for.

The reason why the manner of administration is so important lies in the nature of the drug.

Most thyroid medicines contain levothyroxine (available in the market under brand names like Synthroid, Levothroid, Unithroid, Eltroxin, Levoxyl). This is a synthetic version of the thyroid hormone T4. The T4 hormone needs to be first converted to the active form of thyroid hormone, T3 for it to be effective. This conversion process takes a long time and therefore diet, precautions, time and manner become extremely important.

Conventional drugs (Cytomel, Thyrolar) or natural thyroid medication that contain the active T3 hormone do not require more than a couple of hours to get absorbed in the body. And therefore the various precautions that need to be taken along with these drugs are limited. The small random studies and surveys that have been conducted on determining the best method of administration have focused more on levothyroxine.

Any thyroid treatment, including alternative thyroid treatments therefore focuses on drugs and supplements that can ensure faster absorption of the hormone into the body.

The various opinions that exist among practitioners are in the context of

* The best time to take the medicine.
* Whether the medicine needs to be taken on an empty stomach or after meals?
* The key foods that need to be avoided while the medicine is getting absorbed?
* The other precautions that need to be taken while on thyroid medication?

The general advice the physicians give to ensure quick absorption is to avoid certain things at all times. These need to be avoided totally for at least two to four hours after taking the thyroid pill.

Why Is There Even Debate Over Female Thyroid Testing? Patient Advocate Says Pregnant Women and Their Babies.Deserve Proper Thyroid Diagnosis and Treatment

2010-06-16T11:08:00.000-07:00

The launch of a new clinical trial looking at pregnancy and thyroid disease -- and the implications for babies -- has focused debate on the value of screening and treating pregnant women for thyroid conditions.

The nation's leading thyroid patient advocate, Mary Shomon, urges women to think twice, however, about participating in the study, and to be aware of important guidelines when it comes to thyroid disease and pregnancy, and the birth and health of their babies.

The clinical trial announced this week is titled, "Thyroid Therapy for Mild Thyroid Deficiency in Pregnancy," and is being conducted by the National Institute of Child Health and Human Development.(1) NICHD will work with university researchers at various centers around the country to enroll 1,000 pregnant women with mild hypothyroidism. Half the women will receive a thyroid hormone replacement drug treatment, and half will be untreated, receiving instead an inactive placebo pill.

The women participating in the trial will have a monthly thyroid evaluation during pregnancy. Researchers will evaluate each baby's intellectual development annually, from birth until age five. The researchers are examining the effects of failing to treat mild hypothyroidism on pregnancy and a child's intellectual development. The results of this study are supposed to finally resolve a controversial, ongoing question: should thyroid screening and treatment be universal for all pregnant women?

Thyroid patient advocate Mary Shomon, has major concerns about the study. "For years, significant research has already shown that untreated hypothyroidism -- including mild, subclinical forms of the condition -- is linked to problems in pregnancy and to developmental concerns such as lower IQ in children," says Shomon. "Why would researchers now ask pregnant women to participate in a trial where half of them won't even receive treatment? I'm afraid that this study could endanger the health of pregnant women, and put their unborn babies needlessly at risk."

Proper thyroid function is especially important during pregnancy, because the mother's gland must, at times, produce "thyroid hormone for two." Especially critical are the first 13 weeks, when the baby's developing thyroid can't produce any hormone at all, yet the hormone is necessary for proper brain development. Babies born to hypothyroid mothers, those who are not treated, are at increased risk of developmental problems, including a lower IQ, and in severe cases, even mental retardation and cretinism.

Untreated hypothyroidism in pregnancy can also contribute to infertility, early and recurrent miscarriages, pre-term labor and stillbirth.

According to Shomon, "Almost three years ago, the American Thyroid Association came out with a public health statement that said 'Pregnant mothers with overt or subclinical hypothyroidism are at an increased risk for premature delivery.' That same statement also made it clear that children born to women who were hypothyroid during pregnancy are at risk of impaired intellectual and motor skills." (2)

"Why would women participate in a study that will deny some of them hypothyroidism treatment while pregnant, especially given what we already know about how treatment may reduce the risk of miscarriage, pre-term labor, stillbirth, and developmental problems in our children?" asks Shomon.

Mary Shomon has the following practical, patient-oriented recommendations for women related to pregnancy and thyroid disease:

1. If you're planning a pregnancy, get a pre-conception thyroid test, and take a good pre-natal vitamin. "Many women are so careful when they're trying to get pregnant.," says Shomon. "We stop drinking coffee, avoid medications, and get our immunizations. But women who want to ensure the best possible outcome for themselves and their babies baby should also get a thyroid test, and make sure to take a pre-natal vitamin that includes both iodine and folic acid."

2. If you're pregnant, have your thyroid tested during your first trimester. According to Shomon, "Pregnancy is a time when thyroid problems are more common. But symptoms like fatigue, weight gain and depression are often assumed to be related to the pregnancy, instead of an underactive thyroid, so it can be harder to detect. There are enough studies that suggest even low-level hypothyroidism can contribute to miscarriage, pre-term labor, stillbirth, and cognitive problems in children. Given how hard it is to pick up on the symptoms, the millions of women who are undiagnosed, and the implications for children when a mother is not treated, I am in favor of universal screening for all pregnant women early in the first trimester."

3. If you have any family history of thyroid or autoimmune disease, pay particular attention to your thyroid. "Thyroid and autoimmune disease can run in families, so if you have any history, you want to be especially sure, at minimum, to have pre-conception and first-trimester thyroid testing," says Shomon.

4. Women who already are hypothyroid should ensure that their thyroid levels are optimized before pregnancy. Then, confirm the pregnancy as early as possible, and get frequently tested during the first trimester and throughout the pregnancy. "Research shows that most hypothyroid women require a 50% to 85% increase in their thyroid medication dosage during early pregnancy, especially in the first 8 weeks," says Shomon. "You need to begin pregnancy at a sufficient dose, and then get in to the doctor as early as possible after conception to test and readjust your medication, and continue to be monitored frequently during your pregnancy."

Having a healthy pregnancy with a thyroid condition is the focus of several key chapters of Mary Shomon's latest book, "The Thyroid Hormone Breakthrough: Overcoming Sexual and Hormonal Problems at Every Age." Shomon is the New York Times bestselling author of a number of thyroid and health books, including "Living Well With Hypothyroidism," and "The Thyroid Diet.

In addition to information on how to manage thyroid disease during pregnancy, "The Thyroid Hormone Breakthrough" offers step-by-step guidance on how to differentiate thyroid symptoms from women's hormonal problems. The book arms women with the knowledge and practical tools they need to find the right practitioner, get properly diagnosed, and effectively relieve conditions and symptoms with approaches chosen from among the best conventional and holistic therapies.

In addition to pregnancy, "The Thyroid Hormone Breakthrough" provides practical, hands-on advice to help women harness the power of proper thyroid function to resolve:

* Early or late puberty
* PMS, and irregular, heavy or painful periods
* Low sex drive
* Infertility and recurrent miscarriage
* Severe morning sickness
* Post-partum depression and weight gain
* Difficulty breastfeeding, low milk supply
* Perimenopause and menopause symptoms

"The Thyroid Hormone Breakthrough" features a detailed Risks and Symptoms Checklist to help pinpoint thyroid and hormonal issues, along with thyroid treatment and hormone balancing-solutions for better health. A full range of treatment options are explored, ranging from conventional prescription treatments, to bioidentical hormones, to supplements, to mind-body approaches. The detailed Resources section provides a wealth of information on experts, web sites, and other support. A special section teaches women how to chart their menstrual and fertility cycle, and includes charting tools. Readers will come away empowered with the tools and knowledge they need to overcome thyroid-related hormonal problems, from puberty, to PMS, to pregnancy, to perimenopause.

Shomon's book has an accompanying website -- http://www.thyroidbreakthrough.com -- where women can take an interactive quiz to help learn whether their symptoms may be thyroid-related. A free downloadable ebook provides an overview of the thyroid/hormone connection. A free chapter from "Thyroid Hormone Breakthrough" is also available online.

Mary Shomon was diagnosed with the thyroid condition Hashimoto's thyroiditis in 1995, and has transformed her health challenges into leadership as America's leading thyroid patient advocate. She has worked for more than 25 years in writing and grassroots communications and is the founder and editor-in-chief of several thyroid, autoimmune, and nutrition newsletters, as well as the Internet's most popular independent thyroid website, http://www.thyroid-info.com. Shomon's 2004 book "The Thyroid Diet" was a New York Times bestseller, and a Quills Award semi-finalist. She is also author of a number of recent bestselling books, including "Living Well With Hypothyroidism," "Living Well with Graves' Disease and Hyperthyroidism," "Living Well With Autoimmune Disease," and "Living Well With Chronic Fatigue Syndrome and Fibromyalgia," all published with HarperCollins. Since 1997, Shomon has also served as guide for the About.com Thyroid site at http://thyroid.about.com . Mary Shomon is one of the first patient members of the American Academy on Communication in Healthcare and is a member of the Endocrine Society.

Antithyroid Drugs to Treat Graves’ Disease, Hyperthyroidism and Overactive Thyroid Conditions

2010-06-16T11:06:00.000-07:00

Antithyroid drugs -- also referred to as thionamides -- are medications that treat an overactive thyroid (hyperthyroidism) by blocking the thyroid gland's ability to produce thyroid hormone. In the treatment of an overactive thyroid (which most commonly results from the autoimmune condition Graves' disease), it is critical to slow down the gland's excess production of thyroid hormones, especially the hormones thyroxine (T4) and triiodothyronine (T3). This article provides an overview of of the key antithyroid drugs, including methimazole (Tapazole), propylthiouracil (usually abbreviated as PTU), and the popular antithyroid outside the U.S., carbimazole. Find out more about antithyroid drugs used to treat Graves' disease and hyperthyroidism.

Survey on Complementary and Alternative Medicine for Thyroid Cancer Patients

2010-06-16T11:04:00.000-07:00

The Light of Life Foundation for Thyroid Cancer is conducting a survey on the use of complementary and alternative medicine among thyroid cancer patients. To participate in the survey, please read the following message from Dr. Jennifer Rosen and Dr. Stephanie Lee of the Boston Medical Center:
"Many of our thyroid cancer patients are trying additional treatments for their care. Dr. Jennifer Rosen and Dr. Stephanie Lee at the Boston Medical Center would like to better understand if these treatments influence traditional cancer therapy. We need your help in a research study by completing this questionnaire on Complementary and Alternative Medicine Use. Participation in this study is completely voluntary and the information collected will be kept anonymous - this means that your name and other identifying information is not asked for and not used. This information may be used for future publication. You can refuse to participate and such a decision will not affect your medical care now or in the future. If you have additional questions, please contact Dr. Jennifer Rosen at either 617-414-8016 or jennifer.Rosen@bmc.org or Dr. Stephanie Lee 617-638-8530. This survey should take about ten minutes to complete. Please do NOT complete this survey if you have done it before! Thank you for your help."

Coaching Can Help Older Adults Speak Up at Medical Visits

2010-06-16T11:02:00.001-07:00

Coaching sessions can help seniors become more assertive during medical visits, suggests a new review of studies on methods to increase older patients’ involvement in their own health care.

“Elderly patients should … have more of a say in not only treatment decisions but they should be supported during the whole consultation to make clear their needs and expectations about their health care,” said lead author Raymond Wetzels, a general practitioner at the Radboud University Nijmegen Medical Center in the Netherlands.

Even when coaching and handouts are provided to encourage elderly patients to play a more active role in their care, a majority may remain uninvolved in their doctor visits, one of the reviewed studies found. In this study, more than half of the patients, 54 percent, had not identified specific issues to discuss before their visit to the doctor. Further, 80 percent did not bring a list of questions, problems or medications to the visit and asked no questions about their illness or tests or procedures. And 77 percent did nothing whatsoever to prepare for their visits.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The review, of three studies encompassing 433 patients, focused on two basic types of interventions: face-to-face coaching sessions, either individually or in a group, and written material such as booklets or a checklist to prioritize reasons for the visit. Two of the studies combined these types of interventions, while a third study used only coaching sessions.

More-involved patients tend to adhere to advice better, Wetzels said. This involvement is particularly important for elderly patients because they tend to have more contact with doctors. While figures vary, an estimated 80 percent of people over age 65 have at least one chronic condition, and 65 percent have multiple conditions.

For a variety of reasons, some elderly patients are reticent when dealing with doctors. In some cases, the problem is simply impaired hearing or vision. Seniors dealing with dramatic environmental changes such as the loss of a spouse or moving to new living arrangements may also have difficulty communicating with doctors.

But there are other explanations, said Ming Tai-Seale, an associate professor at Texas A&M Health Science Center. Tai-Seale, who recently wrote a separate review focusing on elderly patients and office visit time, said older patients “may be of the generation where they still see doctors as superior beings. They wouldn’t challenge their opinion. They may feel they are taking too much of the physician’s time.” Older patients “may not be as information savvy as some in the younger generation.”

But one patient left an impression on Tai-Seale: “She was a former city councilwoman. She held the floor throughout the visit. She would make sure that the physician addressed her concerns,” Tai-Seale said. “The conversation was among two equals.”

For patients unable to be assertive, face-to-face coaching sessions may help, according to one of the studies in the Cochrane review.

The 45 study patients were divided into an intervention group and a control group. Before patients in the intervention group visited the doctor, a medical student interviewed them and helped identify questions about their treatment. Of that group, 14 of 22 patients asked at least one question during their visit with the physician. In the control group, eight of 23 patients asked at least one question.

But to some degree, the intervention may have influenced study results in that “patients entering the doctor’s office with a booklet, cue card or question list may have been identified by the doctor as belonging to the intervention group, which may have influenced the doctor’s attitude,” Wetzels said.

While all participants in these studies were 65 or older, the average age was 72 in one study and 77 in another. Two studies had low patient numbers, the reviewers said, and because evidence was limited, they couldn’t recommend specific interventions in daily practice.

Asked if there is an argument for more education aimed at doctors, Wetzels said that doctors already get that training. The trend is toward patient-centered care where both “patients and doctors are responsible for patients’ health care.”

Future studies should focus on follow-up after seniors are coached. “The follow-up should be at least a year after an intervention, but ideally even longer,” according to Wetzels.

“But perhaps more important is to measure objective health outcomes,” he added. For example, an objective measure could be the walking distance of an osteoarthritis patient six months to one year after the intervention.

There should be a balance, the reviewers concluded, between respecting a patient’s autonomy and stimulating active participation in health care.

Wetzels R, et al. Interventions for improving older patients’ involvement in primary care episodes (Review). Cochrane Database of Systematic Reviews 2007, Issue 1.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

Safe Workouts For Cold Weather Months

2010-06-16T11:01:00.001-07:00

With the temperatures plummeting this time of year, many of us tend to hibernate inside our homes. But, hibernating is for bears. As humans it's important to stay active through all four seasons. Yet, a poll of 5,000 people found that 30 percent get no exercise at all during the winter months.

Just because it is cold outside doesn't make it open season for an excuse not to exercise. There are multiple exercise options one can choose to participate in regardless of what the outdoor thermometer reads. Depending on your location and likes, you can choose to workout inside or outside.

All that is required for winter-time workouts is some planning and employing all safety precautions. If you prefer to workout outside, keepthe following tips in mind.

Get warm first. A proper warm-up is critical. Cold temperatures can make your muscles tight and therefore they are more prone to injuries. So, it's important to get them warmed-up prior to engaging in intense physical
activity.

Insulate your body. The best approach to dressing for outdoor exercise is with layers. Layering provides the most effective heating method, plus it allows you to remove the top layer if you get too hot. The layer
closest to your skin should allow moisture to be wicked away. The top layer should be both wind and water resistant.

No sweat. Don't assume that you have to sweat in order to get a good workout. You should avoid sweating that causes the clothing layer closest to your skin to get wet and cause you to be chilled. Instead monitor your
intensity through a heart rate monitor or the Rating of Perceived Exertion.

Don't strip when you get inside. While you may be tempted to immediately remove your layers when returning inside, give your body time to adjust. Post exercise hypothermia is possible. This happens when your body rapidly loses its heating stores.

Drink up. It's just as important to stay hydrated when exercising in winter as it is in summer, even though you might not feel as thirsty.

Lighten up. If possible, it's best to exercise outdoors during daylight areas. But, with shorter days that can be difficult to do. If you exercise outdoors when it is dark, wear reflective materials to ensure that you can
be seen.

If the thought of getting outside to exercise makes you dive under the covers, instead choose one of the many indoor workout options. Below arejust a few of the many choices.
Walk at an indoor location, like a mall. If you need extra motivation to get yourself to the mall, join a walking group. This will help you stay accountable to someone other than yourself.
Join a health club. This will allow you a large variety of physical activities to choose from every week.
Create a home gym. This doesn't have to be expensive. You can easily set-up a great workout routine with just a set of dumbbells, an exercise ball and a jump rope. Get all of this for around $50.
If you have stairs where you live or close by, spend as little as 20 minutes at a time climbing up and down the stairs for a very intense and efficient workout.
Get wet. Find a local indoor pool you can use. Try swimming, water aerobics, or even just walking or running laps in the water.
Visit a library. Usually local libraries offer exercise videos you can check-out for free. Pick-up a new one to try out every time you return the previous video.

By staying fit during winter you'll be able to avoid gaining weight, have a head start on swimsuit season, and avoid losing strength and stamina caused from inactivity. Just as tulips need winter nourishment from the Earth to strongly bloom in spring, humans need to continue to nourishtheir bodies during winter so they too can bloom come spring.

More information about thyroid health.Antithyroid generics Drugs.

THYROID BLOOD TESTS

DIAGNOSIS AND TREATMENT

SIGNS AND SYMPTOMS OF THYROID DISEASE

Nodules/Lumps

Goiter/Enlargement

Autoimmune Thyroid Disease

COMMON THYROID DISEASES AND CONDITIONS(part2)

COMMON THYROID DISEASES AND CONDITIONS

ABOUT THE THYROID Disease(part2)

ABOUT THE THYROID Disease

Causes of Thyroid Cancer

It’s stress week in Canada

Sports and stress are heating up.

Were you or a loved one waiting in a line last weekend to buy the latest “Call of Duty: Black Ops” computer game?

Another acronym to know in the immune balance story: EDC

Clinical Thyroidologists: What we do for our patients.

Name of Prescription Drug.

Name of Prescription Drug

Actoplus Met 15/500mg and 15/850mg

Ambien CR 6.25mg and 12.5mg

Duetact 30/2mg and 30/4mg

Emend 40mg capsule

Enbrel 25mg vials

Enbrel 25 mg syringes

Enbrel 50mg syringe/auto injectors

Humira 40mg syringe/pen

Humira Crohn’s Starter Pack

PATIENT INFORMATION LEAFLET - BREAST DISORDERS

RED Specialist prescribing only,AMBER Prescribe under shared-care protocol

Palivizumab

Paricalcitol

Phenoxybenzamine

Pilocarpine tablets

Tegafur

Temozolomide

Vinorelbine

Zolendronic acid

All drugs for pulmonary hypertension

Enzyme replacement therapy

Total Parenteral Nutrition

Immunoglobulins

Penicillamine

Nandrolone

Nicorandil

Pergolide

Pericyazine

Phenelzine

Phenobarbital

Phenytoin

Pilocarpine eye drops