The following was extracted from an article published in Endocrine Today, reporting on results of a study published recently in Diabetes Care (Li Y. Diabetes Care. 2012;35:273-277): 

From 1996 to 2008, rates of lower-limb amputations among US adults with diabetes decreased by 65%. Nevertheless, in 2008, data from a study conducted by CDC researchers demonstrated that patients with diabetes are still much more likely to require amputation.

“Our results showed substantial decreases in amputation rates in the US diabetic population aged 40 years or older, with rates declining by 65% from 1996 to 2008 (from 11 to 4 per 1,000),” study researcher Nilka Ríos Burrows, MPH, told Endocrine Today. “However, the amputation rate in 2008 was still about eight times higher among people with diabetes compared with those without the disease, indicating a need for additional efforts to further reduce the excess risk for amputation among people with diabetes.”

To evaluate trends in rates of hospitalization for nontraumatic lower-extremity amputation between adults with diabetes and those without the disease, Yanfeng Li, MD, MPH, Burrows and colleagues examined data from the National Hospital Discharge Survey on lower-limb amputation procedures and the National Health Interview Survey on diabetes prevalence from 1988 to 2008.

Although results revealed a sharp increase in diagnosed diabetes throughout the study period, the estimated number of diabetes-related lower-limb amputations decreased dramatically from 11.2 to 3.9 per 1,000 patients, with an annual percentage change of 8.6% (P<.01). In comparison, amputation rates among those without diabetes changed little, with researchers noting only a 0.7% annual percentage change (P>.05). Even so, the age adjusted amputation rate in 2008 for patients with diabetes was 3.9 vs. 0.5 per 1,000 for those without the disease, according to study data.

The researchers also found that, among patients with diabetes, men had higher age-adjusted rates of leg and foot amputations in 2008 when compared with women (6 vs. 1.9 per 1,000 patients), and black patients had higher rates when compared with white patients (4.9 vs. 2.9 per 1,000 patients). Amputation rates were also highest among patients aged 75 years and older (6.2 per 1,000 patients) vs. other age groups.

Despite the encouraging data, Burrows said patients with diabetes must remain vigilant.

“People with diabetes need to check their feet daily for sores and injuries and also have their feet examined by a doctor at least once a year,” she said. “Further decreases in rates of amputations will require continued awareness of diabetes and its complications among patients and providers as well as comprehensive interventions to improve foot care and overall care for people with diabetes and reduce risk factors for amputation.”

To find out more, Burrows said patients should visit the CDC website:

http://www.cdc.gov/features/diabetesfoothealth/.

A long-term study of several thousand women over 65 who had baseline bone density testing was published in NEJM January 2012.  The purpose was to try to determine how long it might take for a patient who does not have osteoporosis to develop it. In short, it depends how bad the bone density is to start with.  What is making headlines seems to be the idea that if bone density is normal (or nearly so) at baseline that it might be reasonable to wait another 15 years before checking again.  The authors make this conclusion because very few individuals will actually become osteoporotic in that timeframe if BMD is normal at baseline.  That is certainly a long time.  Health insurance plans may jump at the chance to further restrict access to this useful technology.  And, I think if they do it thoughtfully that that might even be reasonable.  On the other hand, this same study also concludes that patients who have more advanced osteopenia should be monitored more closely with repeat exams as soon as 1 year later.  Other patients in-between could be re-examined in a more moderate time-frame of 3 to 5 years.  So, from my perspective, if the health insurance plans appropriately liberalize access to use of DXA technology for bone density measurement on the patients with more advanced osteopenia, and allow us to use some clinical judgement on the others, restrictions on use of the technology for those with higher bone density to start with would not be met with much objection.  Time will tell how this data will be handled and if it is done thoughtfully and with the best interests of the public health in mind. 

Now, let’s talk more generally about testing.  Health care costs in the US are rising unsustainably and have placed great burdens on family, employer and government budgets.  Medical tests are a big part of health care costs.  But, the same test may have great value for one situation and very little value in another.  Judicious use of testing will improve quality of care and reflect responsible awareness of costs.  We here at TEG welcome thoughtful discussion about use of various tests and interventions to promote high-value, cost-conscious care.

Obstuctive Sleep Apnea (OSA) is not what I would consider an “endocrine problem.”. However, it is of great concern to us because of it’s extraordinary prevalence in our patients with type 2 diabetes.  Symptoms typically include snoring, daytime fatigue and difficulty losing weight.   It has long been recognized that treatment with use of a mask gently blowing air through the nose or mouth while sleeping can effectively treat symptoms of OSA.  Importantly, OSA is also recognized to increase risk for cardiovascular death.  OSA is two-three times more common in men and more data is available on treatment in men.  A study published in the January 2012 issue of Annals of Internal Medicine reported on the comparison of treatment vs no treatment in over 1000 women with OSA.  They found substantially higher rates of death in those with untreated severe OSA.  Those who used treatment at least 4 hours per night had rates of death as low as those women who did not have OSA.  So, it is important to recognize this problem not only because we want to know if this risk factor for cardiovascular death is present, but because there is a simple treatment available that can completely eliminate this excess risk.  If your provider here recommends referral to a sleep center for evaluation and treatment, this is why!  If they find that you don’t have this problem, great!  If you do, rest assured that treatment can not only improve quality of life, but also eliminate the excess risk for cardiovascular death that is associated with severe, untreated OSA, including affected women. 

Ann Intern Med 2012;156:115-122.

Maybe.  Actos is a drug for treatment of diabetes that is clearly quite effective.  There has been information in the package insert about bladder tumors since 2006, so this question isn’t new.  However, there has been a lot in the lay press lately.  And, many ads from lawyers are popping up in the newspaper every day. 

In the original data on a few thousand patients submitted to the FDA there were 6 cases (0.16%) of bladder cancer in patients on Actos and 2 cases (0.05%) in those not on Actos.  There is an ongoing study to try to clarify the question of whether there is an association or not.  It is a 10 year epidemiological study by the University of Pennsylvania and Kaiser Permanente Northern California.  An interim analysis was published in Diabetes Care April 2011.  They reported that the association was not yet clear, but the study continues.  There does appear to be a possible increased risk for bladder cancer with long-term use of Actos, and this is an issue that will need to be monitored.  That risk is clearly small (0.03%) but further observation over time will be needed to tell if this risk is statistically significant or not.  If you are seeing reports of a 40% increase in risk (which does sound like a lot!) that is just a manipulation of the data to sound more scary.  If the risk exists at all it is an increase in number from 0.07% to 0.10%.  Yes, relatively speaking that is a 40% increase in risk, but again, the difference is only 0.03%.  That is a reasonably small number and the difference between groups could just be related to random chance. 

So, while we acknowlege that there may be a small risk, there is clear benefit to be gained from judicious use of this and other medications for control of diabetes.   It is certainly reasonable to discuss this concern with your physician.  In many cases the best option may be to continue this medication.  In others, there may be a better choice.  Please be sure to discuss this with your provider the next time you are here for a visit if this is a concern for you.

We at The Endocrine Group have expanded our services to include Podiatric care.  We are delighted to add Dr Michael Dolen to our dedicated team, and he is available to see patients immediately. 

Orignially from the Capital District, Dr Dolen studied Podiatric Medicine at Temple University before completing a 3-year residency in Kingston.  He is a member of the American Podiatric Medical Association and the American College of Foot and Ankle Surgeons.  

His specialty here is in diabetic foot care, including wound care and limb salvage, as well as reconstructive and corrective foot surgery.  He will continue to provide general podiatric care for a full spectrum of problems, including:  arthritis, trauma and sports medicine, gout, neuroma and cysts, gout, heel pain, ankle pain, tendonitis, hammertoes and bunions, plantar warts, corns and callouses, fungal and ingrown nails, etc.   

And, the first new Endocrinologist to Albany in years, Dr Erik Cohen joins us July 2011 also.  Erik has been in a Florida practice for a number of years and is transferring to the seasonal weather of the Northeast.  His schedule is filling rapidly, but as always, if you have an Endocrine problem that needs attention we will be sure to get you in for an appointment and take care of it. 

We are thrilled with the addition of these two new providers to our practice and we are confident that they will  help us to serve you even better.

A Joint Statement from the American Association of Clinical Endocrinologists, the American Thyroid Association, The Endocrine Society, and the Society of Nuclear Medicine
March 18, 2011

The recent nuclear reactor accident in Japan due to the earthquake and tsunami has raised fears of radiation exposure to populations in North America from the potential plume of radioactivity crossing the Pacific Ocean. The principal radiation source of concern is radioactive iodine including iodine-131, a radioactive isotope that presents a special risk to health because iodine is concentrated in the thyroid gland and exposure of the thyroid to high levels of radioactive iodine may lead to development of thyroid nodules and thyroid cancer years later.  During the Chernobyl nuclear plant accident in 1986, people in the surrounding region were exposed to radioactive iodine principally from intake of food and milk from contaminated farmlands. As demonstrated by the Chernobyl experience, pregnant women, fetuses, infants and children are at the highest risk for developing thyroid cancer whereas adults over age 20 are at negligible risk. 

Radioiodine uptake by the thyroid can be blocked by taking potassium iodide (KI) pills or solution, most importantly in these sensitive populations. However, KI should not be taken in the absence of a clear risk of exposure to a potentially dangerous level of radioactive iodine because potassium iodide can cause allergic reactions, skin rashes, salivary gland inflammation, hyperthyroidism or hypothyroidism in a small percentage of people. Since radioactive iodine decays rapidly, current estimates indicate there will not be a hazardous level of radiation reaching the United States from this accident. When an exposure does warrant KI to be taken, it should be taken as directed by physicians or public health authorities until the risk for significant exposure to radioactive iodine dissipates, but probably for no more than 1-2 weeks. With radiation accidents, the greatest risk is to populations close to the radiation source.  While some radiation may be detected in the United States and its territories in the Pacific as a result of this accident, current estimates indicate that radiation amounts will be little above baseline atmospheric levels and will not be harmful to the thyroid gland or general health. 

We discourage individuals needlessly purchasing or hoarding of KI in the United States. Moreover, since there is not a radiation emergency in the United States or its territories, we do not support the ingestion of KI prophylaxis at this time. Our professional societies will continue to monitor potential risks to health from this accident and will issue amended advisories as warranted.

The American Association of Clinical Endocrinologists and the American Diabetes Association joint statement in response to American College of Physicians (ACP) clinical guidelines for inpatient glucose control:

The publication of the systematic review of intensive insulin therapy in hospitalized patients and the American College of Physicians (ACP) clinical guidelines for inpatient glucose control in the February 15^th issue of Annals of Internal Medicine has again raised the issue of optimal management of hyperglycemia in the hospital.

The American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) have published updated guidelines for treating high blood glucose while avoiding low blood glucose in hospitalized patients. The main objectives of the 2009 AACE/ADA recommendations were to identify reasonable, achievable, and safe glycemic targets and to describe the protocols, procedures, and system improvements needed to facilitate their implementation. For most patients a blood glucose target of 140-180 mg/dL is recommended and appropriate use of insulin is the preferred approach for achieving safe, optimal glucose control.

 “Hyperglycemia in hospitalized patients is common and  associated with increased risk of infection, mortality, and increased cost,” said AACE President Daniel Einhorn, MD, FACP, FACE. “Although near normalization of glucose in these patients appears to be of no greater benefit than moderate glycemic targets, ignoring hyperglycemia in this population is no longer acceptable.”

There is substantial observational evidence linking hyperglycemia in hospitalized patients (with or without diabetes) to poor outcomes. Although initial small studies suggested that intensive glycemic control (insulin infusion with goal blood glucose targets of 80-110 mg/dl) improved outcomes in surgical  ICU and medical ICU patients, subsequent trials have failed to show a  benefit or have even shown increased mortality of intensive targets compared to more moderate targets (140-180 mg/dl).  Moreover, these recent studies have highlighted the risk of severe hypoglycemia resulting from attempts to completely normalize blood glucose.

 “Both over treatment and under treatment of hyperglycemia in hospitalized patient are patient safety issues,” said Robert R. Henry, MD, President, Medicine and Science for the American Diabetes Association. “Coordinated, interdisciplinary teams have been shown to achieve both safe and effective control of hyperglycemia in hospitalized patients.”

The recent ACP guidelines are for the most part consistent with the AACE/ADA recommendations.  AACE/ADA maintains that the upper limit of 180 mg/dl is safe and justified by data on benefits of glycemic control and the harms of uncontrolled hyperglycemia. Practitioners should take heart in the commonality of recommendations among all the organizations to address hospital hyperglycemia in the safest manner.

The American Association of Clinical Endocrinologists is the world’s largest professional medical organization of clinical endocrinologists with more than 6,500 members in the United States and 91 other countries. AACE members are physicians who specialize in endocrinology, diabetes, and metabolism.  For more information about AACE, visit our Web site at www.aace.com, become a fan on Facebook at www.facebook.com/theaace or follow us on Twitter at www.twitter.com/theaace. 

The American Diabetes Association is leading the fight to stop diabetes and its deadly consequences and fighting for those affected by diabetes. The Association funds research to prevent, cure and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes. Founded in 1940, our mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. For more information please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or visit www.diabetes.org. Information from both these sources is available in English and Spanish.

“One half of all postmenopausal women will have an osteoporosis-related fracture during their lifetime, including 25% who will develop a vertebral deformity and 15% who will suffer a hip fracture,” write USPSTF Chair Ned Calonge, MD, MPH, from the Colorado Trust in Denver, and colleagues. “Osteoporotic fractures, particularly hip fractures, are associated with chronic pain and disability, loss of independence, worsened quality of life, and increased mortality. Although hip fractures occur less commonly in men than in women, more than one third of men who sustain a hip fracture will die within 1 year.”

Approximately 12 million Americans older than 50 years are expected to have osteoporosis by 2012. In addition to female sex and white race/ethnicity, other risk factors for osteoporosis include smoking, alcohol intake, low body mass, and parental history of fractures. To estimate 10-year risks for fractures, the USPSTF used the FRAX tool because it relies on easily obtainable clinical information, it was extensively validated in 2 large US cohorts, and it is freely accessible by clinicians and by the public.

Because the risk for fractures continues to rise with increasing age, the USPSTF did not specify an age limit at which screening should no longer be performed. When deciding whether to screen patients with significant morbidity, however, clinicians should consider the remaining lifespan.

The updated recommendations were based on a USPSTF assessment of available evidence on the diagnostic accuracy of instruments to determine osteoporosis and fracture risk, the utility of dual-energy x-ray absorptiometry (DXA) and peripheral bone measurement tests in predicting fractures, the potential harms of osteoporosis screening, and the potential benefits and harms of pharmacotherapy for osteoporosis in women and in men.

In terms of detecting osteoporosis, the USPSTF found convincing evidence that bone measurement tests such as DXA of the hip and lumbar spine and quantitative ultrasound of the calcaneus predict short-term risk for osteoporotic fractures in women, as well as in men. Evidence is adequate that clinical risk assessment instruments are only modestly predictive for low bone density or for fractures.

To date, no controlled studies have assessed whether screening for osteoporosis offers any benefits in terms of detection and early treatment, such as lower fracture rates or fracture-related morbidity or mortality.

Available evidence is convincing that drug treatment lowers the risk for fractures in postmenopausal women who have no previous osteoporotic fractures. The USPSTF determined that the magnitude of benefit of treating screening-detected osteoporosis is at least moderate in women 65 years of age or older, and in younger women whose fracture risk is at least as great as that of a 65-year-old white woman with no additional risk factors.

Treatment options include sufficient intake of calcium and vitamin D and weight-bearing exercise. Several drugs have been approved by the US Food and Drug Administration to prevent fractures, including bisphosphonates, parathyroid hormone, raloxifene, and estrogen.

“The choice of therapy should be an individual one based on the patient’s clinical situation and the tradeoff between benefits and harms,” the statement authors write. “Clinicians should provide patient education on how to use drug therapies to minimize side effects.”

Because of the absence of randomized trials of primary fracture prevention in men who have osteoporosis, evidence was deemed inadequate to determine whether pharmacotherapy lowers fracture risk in men with no history of osteoporotic fractures.

Since publication of the 2002 USPSTF osteoporosis screening recommendation, the USPSTF has found no new studies evaluating harms of screening for osteoporosis in men or in women. DXA screening is associated with opportunity costs; namely, the time and effort expended by patients and by the healthcare system.

The specific agent used determines the potential harms of drug therapies for osteoporosis. For bisphosphonates, which are the most commonly prescribed treatments for osteoporosis, the USPSTF found adequate evidence that the harms are no greater than small. For estrogen and selective estrogen receptor modulators, however, the USPSTF found convincing evidence that the harms are small to moderate.

“The USPSTF concludes that for women ages 65 years and older, and for younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors, there is moderate certainty that the net benefit of screening for osteoporosis using DXA is at least moderate,” the statement authors write. “The USPSTF concludes that for men, evidence of the benefits of screening for osteoporosis is lacking, and the balance of benefits and harms cannot be determined.”

Ann Intern Med. Published online January 17, 2011.

What is the thyroid gland?
The thyroid gland is a small, butterfly-shaped gland located in the base of the neck just below the Adam’s apple. Although relatively small, the thyroid gland influences the function of many of the body’s most important organs, including the heart, brain, liver, kidneys and skin. Ensuring that the thyroid gland is healthy and functioning properly is important to the body’s overall well- being.

Hyperthyroidism
When hyperthyroidism develops, a goiter (enlargement of the thyroid) is usually present and may be associated with some or many of the following features:

• Fast heart rate, often more than 100 beats per minute
• Becoming anxious, irritable, argumentative
• Trembling hands
• Weight loss, despite eating the same amount or even more than usual
• Intolerance of warm temperatures and increased likelihood to perspire
• Loss of scalp hair
• Tendency of fingernails to separate from the nail bed
• Muscle weakness, especially of the upper arms and thighs
• Loose and frequent bowel movements
• Smooth skin
• Change in menstrual pattern
• Increased likelihood for miscarriage
• Prominent “stare” of the eyes
• Protrusion of the eyes, with or without double vision (in patients with Graves’ disease)
• Irregular heart rhythm, especially in patients older than 60 years of age
• Accelerated loss of calcium from bones, which increases the risk of osteoporosis and fractures

Hypothyroidism
In its earliest stage, hypothyroidism may cause few symptoms, since the body has the ability to partially compensate for a failing thyroid gland by increasing the stimulation to it, much like pressing down on the accelerator when climbing a hill to keep the car going the same speed. As thyroid hormone production decreases and the body’s metabolism slows, a variety of features may result.

• Pervasive fatigue
• Drowsiness
• Forgetfulness
• Difficulty with learning
• Dry, brittle hair and nails
• Dry, itchy skin
• Puffy face
• Constipation
• Sore muscles
• Weight gain and fluid retention
• Heavy and/or irregular menstrual flow
• Increased frequency of miscarriages
• Increased sensitivity to many medications

Hashimoto’s Thyroiditis
Hashimoto’s thyroiditis may not cause symptoms for many years and remain undiagnosed until an enlarged thyroid gland or abnormal blood tests are discovered as part of a routine examination. When symptoms do develop, they are either related to local pressure effects in the neck caused by the goiter itself, or to the low levels of thyroid hormone. The first sign of this disease may be painless swelling in the lower front of the neck. This enlargement may eventually become easily visible. It may be associated with an uncomfortable pressure sensation in the lower neck. This pressure on surrounding structures may cause additional symptoms, including difficulty swallowing.
Although many of the features associated with thyroid hormone deficiency occur commonly in patients without thyroid disease, patients with Hashimoto’s thyroiditis who develop hypothyroidism are more likely to experience the following:

• Fatigue
• Drowsiness
• Forgetfulness
• Difficulty with learning
• Dry, brittle hair and nails
• Dry, itchy skin
• Puffy face
• Constipation
• Sore muscles
• Weight gain
• Heavy menstrual flow
• Increased frequency of miscarriages
• Increased sensitivity to many medications

The thyroid enlargement and/or hypothyroidism caused by Hashimoto’s thyroiditis progresses in many patients, causing a slow worsening of symptoms. Therefore, patients with either of these findings should be recognized and adequately treated with thyroid hormone. Optimal treatment with thyroid hormone will eliminate any symptoms due to thyroid hormone deficiency, usually prevent further thyroid enlargement, and may sometimes cause shrinkage of an enlarged thyroid gland.

Thyroid Nodule
Most patients with thyroid nodules have no symptoms whatsoever. Many are found by chance to have a lump in the thyroid gland on a routine physical exam or an imaging study of the neck done for unrelated reasons (CT or MRI scan of spine or chest, carotid ultrasound, etc.). In addition, a substantial number are first noticed by patients or those they know who see a lump in the front portion of the neck, which may or may not cause symptoms, such as a vague pressure sensation or discomfort when swallowing. Obviously, finding a lump in the neck should be brought to the attention of your physician, even in the absence of symptoms.

Family History
A familiar place to look for thyroid disorder signs and symptoms is your family tree. If you have a first degree relative (a parent, sibling, or child) with thyroid disease, you would benefit from thyroid evaluation. Women are more prominent thyroid patients than men; however, the gene pool runs through both.

According to a national survey by the American Association of Clinical Endocrinologists (AACE), more than three-fourths (76%) of the population do not know that thyroid disease runs in families.

Other Reasons to Consider a Thyroid Evaluation

Prescription Medications
If you are taking Lithium, Amiodarone, Antithyroid drugs (either PTU or Tapazole), or Levothyroxine, you should consider a thyroid evaluation.

Radiation Therapy to the Head or Neck
If you have had any of the following radiation therapies, you should consider a thyroid evaluation: radiation therapy for tonsils, radiation therapy for an enlarged thymus, or radiation therapy for acne.

Chernobyl
If you have leaved near Chernobyl at the time (1986) of the nuclear accident, you should consider a thyroid evaluation.

Hypothyroidism
Hypothyroidism (underactivity of the thyroid gland) occurs when the thyroid gland produces less than the normal amount of thyroid hormone. The result is the “slowing down” of many bodily functions. Although hypothyroidism may be temporary, it usually is a permanent condition. Of the nearly 25 million people suffering from a thyroid condition, most have hypothyroidism.

Hashimoto’s Thyroiditis
Hashimoto’s thyroiditis (also called autoimmune or chronic lymphocytic thyroiditis) is the most common thyroid disease in the United States. It is an inherited condition that affects approximately 14 million Americans and is about seven times more common in women than in men. Hashimoto’s thyroiditis is characterized by the production of immune cells and autoantibodies by the body’s immune system, which can damage thyroid cells and compromise their ability to make thyroid hormone. Hypothyroidism occurs if the amount of thyroid hormone, which can be produced, is not enough for the body’s needs. The thyroid gland may also enlarge, forming a goiter.

Thyroid Nodules
The thyroid gland is located in the lower front of the neck, above the collarbones, and below the voice box (larynx). A thyroid nodule is a lump in or on the thyroid gland. Thyroid nodules are common, but are usually not diagnosed. They are detected in about six percent of women and one to two percent of men. They are 10 times as common in older individuals than in younger ones. Sometimes several nodules will develop in the same person. Any time a lump is discovered in thyroid tissue, the possibility of malignancy (cancer) must be considered. Fortunately, the vast majority of thyroid nodules are benign (not cancerous).

Hyperthyroidism
Before the development of current treatment options, the death rate from severe hyperthyroidism was as high as 50 percent. Now several effective treatments are available and, with proper management, death from hyperthyroidism is rare. Deciding which treatment is best depends on what caused the hyperthyroidism, its severity, and other conditions present. A physician who is experienced in the management of thyroid diseases can confidently diagnose the cause of hyperthyroidism and prescribe and manage the best treatment program for each patient.

Antithyroid Drugs
In the United States, two drugs are available for treating hyperthyroidism: propylthiouracil (PTU) and methimazole (Tapazole). These medications control hyperthyroidism by slowing thyroid hormone production, and are frequently used for several months after the initial diagnosis of hyperthyroidism to normalize the thyroid hormone levels. Some patients with hyperthyroidism caused by Graves’ disease experience a spontaneous or natural remission of hyperthyroidism after a 12- to 18-month course of treatment with these drugs, and may sometimes avoid permanent underactivity of the thyroid (hypothyroidism), which often occurs as a result of using the other methods of treating hyperthyroidism. Unfortunately, the remission is frequently only temporary, with the hyperthyroidism recurring after several months or years off medication and requiring additional treatment, so relatively few patients are treated solely with antithyroid medication in the United States.

Antithyroid drugs may cause an allergic reaction in about five percent of patients who use them. This usually occurs during the first six weeks of drug treatment. Such a reaction may include rash or hives; but after discontinuing use of the drug, the symptoms resolve within one to two weeks and there is no permanent damage.

A more serious effect, but occurring in only about one in 250-500 patients during the first four to eight weeks of treatment, is a rapid decrease of white blood cells in the bloodstream. This could increase susceptibility to serious infection. Symptoms such as a sore throat, infection, or fever should be reported promptly to your physician, and a blood cell count should be done immediately. In nearly every case, when a person stops using the medication, the white blood cell count returns to normal. Very rarely, antithyroid drugs may cause severe liver problems, which can be detected by monitoring blood tests or joint problems characterized by joint pain and/or swelling. Your physician should be contacted if there is yellowing of the skin (“jaundice”), fever, loss of appetite, or abdominal pain.

Radioactive Iodine Treatment
Iodine is an essential ingredient in the production of thyroid hormone. Each molecule of thyroid hormone contains either four (T4) or three (T3) molecules of iodine. Since most overactive thyroid glands are quite hungry for iodine, it was discovered in the 1940’s that the thyroid could be “tricked” into destroying itself by simply feeding it radioactive iodine. The radioactive iodine is given by mouth, usually in capsule form, and is quickly absorbed from the bowel. It then enters the thyroid cells from the bloodstream and gradually destroys them. Maximal benefit is usually noted within three to six months.

It is not possible to eliminate “just the right amount” of the diseased thyroid gland, since radioiodine eventually damages all thyroid cells. Therefore, most endocrinologists strive to completely destroy the diseased thyroid gland with a single dose of radioiodine. This results in the intentional development of an underactive thyroid state (hypothyroidism), which is easily, predictably and inexpensively corrected by lifelong daily use of oral thyroid hormone replacement therapy. Although every effort is made to calculate the correct dose of radioiodine for each patient, not every treatment will successfully correct the hyperthyroidism, particularly if the goiter is quite large and a second dose of radioactive iodine is occasionally needed.

Thousands of patients have received radioiodine treatment, including former President of the United States George Bush and his wife, Barbara. The treatment appears to be a very safe, simple, and reliably effective one. Because of this, it is considered by most thyroid specialists in the United States to be the treatment of choice for hyperthyroidism cases caused by overproduction of thyroid hormone.

Surgical Removal of the Thyroid
Operating to remove most of the thyroid gland may occasionally be recommended in certain situations, such as a pregnant woman with severe uncontrolled disease in whom radioiodine would not be safe for the baby. Surgery usually leads to permanent hypothyroidism and lifelong thyroid hormone replacement therapy.

by: Lynn Sutton RD,CDN,CDE

The National Weight Control Registry ( www.nwcr.ws/) Has studied weight loss since 1994. Their research compiles information from thousands of participants who have lost an average of 66 # and kept the weight off for an average of 5.5years.

Here’s what works:

• All participants reported they modified their food intake and exercise.
• Diets were low calorie and low fat; diets were varied but all used similar behaviors to lose and maintain weight loss.
• 90% exercise, on average, about 1 hour per day.
• 78% eat breakfast every day.
• 75% weigh themselves at least once a week.
• 62% watch less than 10 hours of TV per week.

How to do it?

Breakfast: Plan ahead, if you are not used to eating breakfast, start small and simple. Have foods ready and available so you don’t have to think much during the morning rush to get out the door.

Can be as simple as:

• 1 piece of fruit and 8 almonds or walnuts, or 2 low fat string cheese.
• 10 Triscuits and Laughing Cow Light Cheese
• Cheese and mustard sandwich on whole wheat bread, prepared the night before.
• Grilled cheese: low-fat cheese, 2 slices whole grain bread grilled in pan prepared with cooking spray.

Summer Smoothie

• 2/3rd cup low-fat cottage cheese
• ½ cup berries (frozen is great)
• 2 tablespoons vanilla or lemon yogurt

Stir or blend in blender for smoother consistency. Eat immediately or place in refrigerator for a thicker consistency.

Per serving: 200 calories, 21 grams of carbohydrate and 18 grams of protein

You can double or triple this recipe and have for the next morning.

French Toast

• 2 slices whole grain bread
• 2 egg whites beaten with 1 tablespoon of fat free milk, 1 tsp cinnamon and 1 tsp vanilla
• Unsweetened ½ cup applesauce or ½ cup of berries

Beat egg whites with milk, cinnamon and vanilla. Place in pre-heated skillet prepared with non-stick spray. Cook until just golden. Place on plate spread with Berries or applesauce sprinkle w/ cinnamon. The toast can be made in a larger batch and slices frozen and popped in the toaster for quick breakfast mornings.

Per Serving: 260 calories, 36 carbohydrates and 19 grams protein.

Exercise

60 minutes may seem like a long time to exercise everyday unless you make it a fun, enjoyable part of your daily routine. Think of exercise as “your time for you”.

If you are not able to get the full 60 minutes in at one time, it still counts if you get 2, 30 minute sessions or 4, 15 minutes sessions.

Television On Demand

If you have cable or dish television, there is “exercise on demand” on Time Warner channel 1067. You will find every kind of exercise: walking, jogging, yoga, Pilates, Sit and Be Fit, Leslie Sansone “walking down your blood sugars”. This all happens right in front of your TV, when you want it.

Read While You Exercise

Get your favorite author book on tape or your Ipod, walk while listening to a murder mystery or a juicy novel.

Log Your Exercise Progress Throughout the Day

Purchase a step-pedometer; they are available and affordable at local department or sporting stores. Put your pedometer on when your feet hit the floor; take it off as you climb into bed. The goal for a great day of exercise is 10,000 steps.

Walk and Talk

Walk with a neighbor or friend, talking makes the time fly. If you can’t walk with them in person, walk with them while talking on the phone. Plan to make your return calls to family or friends while walking.

Reward Yourself

Select and read a great book, go to that movie that seemed so interesting, paint, draw, listen to your favorite music. Do something you never tried before but seemed interesting.