Friday, 30 August 2013

Hyperthyroidism

Dear readers,

I was diagnosed with hyperthyroidism earlier this year, and thought my experience with this condition might be relevant to you guys or your friends and family. 



Do note however, that nothing in this blog post constitutes medical advice, even if I have extensively-researched my condition and spoken to a number of my doctor friends about it. So if you think you have a medical condition, don't come to me, go to a doctor, and seek multiple professional opinions if necessary.

 

Early Signs

Some time last year, I decided that it was time to lose weight in order to pass my IPPT. I used to run on some weekday mornings when my ship was in base, because it was just so convenient to take a shower and do my laundry on board after my run. All this came to halt when my ship went to yard for regular maintenance.

I was subsequently arrowed to be a marching contingent commander for SAF Day Parade. It is a pointless, meaningless, and thankless task, though not any more so for me than the other participants. I hated parades, as I hated standing under the hot sun in our 90% humidity weather. I hated them as they were a complete waste of my time, and didn't appear to benefit anyone in a meaningful way.

I was the reserve for this handsome guy in front. Actually he started off as the reserve, but I soon proved to be so unfit for the job that everyone agreed that I should be on the bench. Suited me fine.


It didn't help that I tended to sweat profusely when shown temperatures above 28 degrees C. Much more so than the average person for the same amount of physical activity. This made stuff like parades supremely uncomfortable.

Another aspect was that I simply wasn't parade-fit. I was chosen for no other reason than my ship being in yard, and I was relatively free-er than my compatriots as a result. I also was appropriately-tall at 1.7-ish meters.

My first few parade trainings were a disaster. I would fall out after something like 15 minutes under the sun, much to my embarrassment. The Navy trainees fresh from BMT were much tougher - understandably. But it is simply humiliating for an officer to fare this poorly.

In hindsight, I was likely hyperthyroid back then, just that I didn't know it. The signs were all clear to see. This was sometime in June-July 2012, (SAF Day is on 5th July, can't be bothered to verify).

Later on in the year, I resumed my physical training regime and found satisfaction in my weight loss and running improvement. Weight loss was occurring surprisingly quickly for me. After one particularly tough sailing aboard another ship, I had lost five kg in as many days. I started at about 73kg, and went down to about 68.

I managed to get a Silver award for IPPT, albeit on my fourth attempt. I'd attribute my performance mostly to the weight loss. In all likelihood I wasn't any fitter, but with five kg less to lug around, I sure could run faster.

My hands had also started to tremor gradually. It had reached a point where without coffee (I drank on average two cups a day on weekdays. Our ship had a very nice coffee machine!), my hands were trembling very noticeably. People noticed and commented, but nobody thought anything of it. I loved my new lean look and I guess a six-pack wasn't too far off if I had trained a bit harder.

This is the exact model we had on board. Couldn't say no to my daily cuppa...

My weight loss continued to about 64kg, and I had trouble with all my pants because they were getting rather loose. This occurred despite a marked increase in my appetite. I really didn't mind, as I love food and wanted to lose weight. I bet most gals and some guys would love to have this disorder indeed!

 

Shit hit the fan?

Hyperthyroidism is a pretty manageable condition, but untreated as I was, it could lead to long-term heart problems, among other issues. It can also give rise to acute conditions such as thyrotoxicosis, also known as "thyroid storm".

Late last year, A landed in hospital, shortly after our 2012 year-end Bali dive trip. She had viral meningitis, which manifested itself by an excruciating headache. To summarise, meningitis is inflammation of the brain lining, and can be a life-threatening condition, especially if it's of bacterial origin. Thankfully, tests showed that it was viral.

Our doctor friend (B) who worked at NUH paid A a visit when I was also visiting, and after a few months of not having met her, she noticed me sweating slightly even in the air-conditioned isolation ward, and that my hands were trembling constantly. Of course, my new lean look didn't go unnoticed, though it wasn't a compliment that she had in store for me.

"I think you have hyperthyroidism," she said, rattling off a list of symptoms of which I probably had 90%. So I resolved to get myself tested at the Changi Naval Base Medical Centre asap. I assumed that if I had lived a few months with it, there wouldn't be any immediate need to get tested on the spot.

A day or two after that, I found myself alone at home (A was still hospitalised) running a 40-degree fever and feeling really weak. I had tried to arrest the fever when it passed 38 but to no avail. So I called for an ambulance, and soon found myself on a drip at the NUH A&E. Happily, the fever abated and I was discharged the next morning, after a few bags of saline and some medicine was fed into my system.

In hindsight, my symptoms sounded suspiciously like thyroid storm, and I should have told them what Dr B had told me. By this time, I was a near-skeletal 59.5kg, and had an unprecedented view of my ribs. I received comments that would make any anorexic blush in delight - the most memorable being that my head "looked like a skull". Frankly, I'd take that any day over my late, great potbelly!

Subsequently before I got tested, there was one occasion after dinner and a few drinks with friends that I went home feeling really weird. While I lay on our bed, I counted my resting pulse at over 130 bpm. Not good.

Diagnosis, prescription, "recovery"...

After I "reported sick" at the medical centre the very next day, the MO concurred with Dr B's initial diagnosis and ordered a thyroid test for me. He also prescribed Propanolol to lower my heart rate, as well as Carbimazole to reduce my thyroid levels. The test results came back a week later as suspected - positive for hyperthyroidism. My dad would later inform me that his mum and sister had this condition as well...

The journey beyond that gets even more boring, if you are still reading by this point. I was referred to an Endocrinologist at NUH and the only thing he did further was to adjust my initial dose of 30mg Carbimazole downwards as my Free T4 levels decreased.


It's very much cheaper to buy from JB. RM 13 from My Pharmacy as of July 2013.
Don't bother finding out the local prices. Chances are if you need this medication, your pulse rate will shoot through the roof upon discovery!
It turned out that 30mg a day made my skin itch. So I was self-medicating on a variety of antihistamines - stuff I had readily available as I always save leftover medicines for future usage. Thankfully, I was gradually reduced to 5mg a day.

The other side effect was weight-gain, even as my previously-voracious appetite decreased. But that was also a function of my metabolism slowing down.

 

 Relapse!

 The only words to describe this are geh kiang (being a smart alec). I decided to take my lone 5mg pill every few days, then the interval got longer. I watched for symptoms of relapse and apparently there were none. I was considerably more tolerant of heat than before, and my weight had stabilised at 64kg, a figure I was happy to maintain. Maybe I could maintain a T4 reading within the higher reaches of the normal range?

Turns out that I couldn't. And the consequences were quite troublesome. None of the symptoms returned in earnest, but the Migration Medical demanded an updated reading, which I didn't have handy with me. So I got tested at the clinic, and lo and behold! "Super hyperthyroid".

I got a earful from my doctor friends and of course, from A. Stuff not quite suitable for publication here. But they were right, I had screwed up.

If not for this, we'd be sitting on an Australian PR now, having cleared all other hurdles. For now, the wait continues...
Meanwhile, after self-medicating to 20mg a day for a couple of weeks and tapering back to 10mg daily, my latest results are A-OK. Lesson learned, take your meds religiously.

Useful information for those in the SAF...
Active hyperthyroidism gets you an immediate downgrade to PES E9L9. Non-negotiable. Not even if you beg the MO. For Navy folks, it means no sailing or shipboard duties. It can be nice, or a buggeration depending on how you see it. I personally found it a buggeration. I loved driving my ship.

Even after your thyroid levels are normal, the highest PES you'd be eligible for is C9. Can sail, but no more IPPT! Now, that's probably a good thing unless you really need that extra $100 (Silver for regular) to $400 (Gold for NSman) every year.

Questions and comments? Shoot... And I will try my best to answer them in the capacity of a hyperthyroidism patient :)
- S

12 comments:

  1. Hi mate,

    It's Grave's disease, discovered by Dr Robert Grave more than a hundred years ago in UK. It is hereditary and affects your immune system.

    This is a poorly understood condition in Singapore. Hyperthyroidism is the general condition. Grave's disease is just one form of hyperthyroidism.

    There many symptoms. Anxiety attacks (feeling of fleeing for safety) are common and screws up your perspective of life and put additional stresses on your work life. Left untreated, heart failure is a possibility with the heart beating at double the normal rate.

    You should consult a specialist to get it under control. Most patients would respond well to carbimazole, a relatively cheap medicine with little or no side effects. And you can stop medication when the condition stabilizes and monitor it annually.

    Just a word of caution. If a specialist recommends killing part of the thyroid through radioactive iodine, think very carefully. You may end up with a permanent Hypothyroidism requiring lifelong thyroxin medicine.

    a fellow sufferer

    ReplyDelete
    Replies
    1. Thanks for the insight. I was more specifically diagnosed with Graves disease. There were other indicators which I left out of the post which I felt might have been a bit technical for laymen already. Not sure how you know my case is Graves... Do I know you? :p

      Yes my antibodies are a bit high. Basically my immune system was raping my thyroid and it reacted by releasing T4 at a much higher rate. Or at least that's what it seems to be now.

      -S

      Delete
    2. You're welcome. Perhaps related. After all the condition is hereditary.

      a fellow sufferer

      Delete
  2. Will it affect your AUS PR application?

    ReplyDelete
    Replies
    1. Good question. There are many ways to tackle your question, and I won't know if I am providing the correct answers, as I don't have a time machine.

      Present Scenario:

      Didn't bring documents to migration medical. Didn't take medicine for about a month too. Went for thyroid screen at migration medical and levels were rather high. Case is referred to Medical Officer of the Commonwealth.

      Possible Outcomes:

      - They grant PR anyway after evaluating the case (but already delayed due to the referral)
      - They ask me go for re-test. (levels ok now, so it's just further delay)
      - Application rejected.

      Possible alternative scenario

      Had I taken my medication and brought my test results (all except the first were ok), I would have presented as euthyroid. That means levels within spec, though they will know that I had this condition and am undergoing treatment. Likely no requirement for referral. At most they will take my reading again to confirm that I'm euthyroid.

      What it really means?

      Hopefully nothing, as we plan to move at the end of the year. Hopefully that's enough buffer time to minimise disruption to our plans.

      Delete
  3. Hi,

    May i ask have you secure a job there?

    And hope you are recovering well from your medical problem.

    ReplyDelete
    Replies
    1. Hi Alvin,

      Thanks for your well-wishes! Unfortunately Graves disease (the subclass of hyperthyroidism) is a chronic autoimmune disease. When managed, I think it's less benign than diabetes, but like diabetes for e.g, I doubt it's going away anytime soon. Thankfully the medicine works reasonably well, with reasonably few side effects at my current dose. It is also cheap if purchased from JB.

      No we have not secured jobs there. Do check out "Myth 4" in our Migration Chapter 2 post. Australia is a little different in this sense.

      But for certain occupations in high demand such as nursing, we have heard from A Singaporean Son's blog that one of his friends went there looking for a job and found an employer willing to sponsor her work visa. I believe this to be the exception rather than the norm.

      -S

      Delete
  4. Hey man,

    Your article really got to me.

    I was diagnosed with Hasimoto Hyperthryoidism in July this year after suffering the symptoms for a month. During that month, I dropped 5 kg in the matter of weeks, suffered breathing difficulties and random muscle weakness. It was really scary because for a couple of days, my legs started to ache for no reason whatsoever. I didn't even exercise or anything.

    I'm also on Camazol and Propranolol now. I didn't try to stop the Camazol, but I did experiment with stopping the propranolol for a day or two. I noticed by the end of the day, my hands started to tremble.

    The thing that really got to me was that the doctors (at AMK polyclinic) said there's no known cause for this and that I have to be on these meds for the next few years. Whenever I ask why, they'd merely reply, "It comes back once the medication is stopped".

    Oh and I also got itchy rash for a few weeks after I started the medication.

    Could you drop me an email here? alden@alden-tan.com

    I just want to talk more about the condition. I got reservist (for the first time in 7 years) next week :(

    ReplyDelete
  5. Hi there,
    Firstly, I share your sentiment of being a hyperthyroid patient. I was diagnose with hyperthyroidism since I was 15 years old. This found to be hereditary from my maternal side. To add on I was allergic to Carbimazole and PTU. Things got worst when i had a relapse and warded in SGH for a month.
    Doctors were at their wits ends and decided to use radio active iodine on me. That was the last resort. Till today I am on 75mgm every morning and 50mgm on Sundays.
    Both me and husband are seriously keen in migration but we just do not know where to start. Would you be kind to give us your 2 cents worth. Will my medical condition affects the visa application? We are seeking for a better life elsewhere with our kids but we kept asking if the grass will be greener on the other side?

    ReplyDelete
    Replies
    1. Hi Natrasha,

      As long as your thyroid hormone levels are within control, there should be no issue clearing the medical.

      You've started at the right place. Digest our blog, and also check out A Singaporean in Australia. Visit the places in Oz you are interested in.

      That's the beginning. After all that, you will answer your own question as to whether the grass is greener here.

      Short answer to you, we are finally home.

      -S

      Delete
  6. Hi there - I was reading about Australia when I came upon this post. Sorry to hear about the hyperthyroid and hope that you've got things in balance. Anyway, can I suggest that you read this: http://rightreads.info/izumio-hydrogen-water-and-super-lutein-for-thyroid-problems/?

    I'll also be reading up on your journey to Australia. I really appreciate what you've advised Natrasha above and hope that I'll be able to answer my own question about whether the grass is greener on the other side.

    ReplyDelete
    Replies
    1. Hi Kit, thanks for the link. Everything is in balance at the moment. Still have high antibody readings, but they have shifted such that there the right amount of thyroid suppression. It seems like I can maintain desirable levels without medicine, but will have to have check ups every few months courtesy of my tax dollars :)

      For a moment I thought you were asking me whether the grass is greener. But am glad that I had misread it at first. You have to find out yourself.

      The grass tends to become greener if you water it. But sometimes it can be hard to water... So far so good for us.

      Whereabouts you thinking of moving to in Oz? I hear very good things about Perth, don't believe what you may read elsewhere on the internet that Perth is full. Some people have vested interest in getting people to migrate to Melbourne instead... ;)

      -S

      Delete