I've gotten by in large part due to Emily's cooking. She studied up on the LID and made some great meals for us, like:
- Spaghetti with tomatoes and lentils
- Homemade hummus
- Whole roasted chicken with rice
- Chicken noodle soup
- Sweet and sour chicken wings
I also have a newly discovered love of oatmeal, which I've been having every morning at work with frozen berries, agave nectar, and coconut milk (free of sea salt or carrageenan).
And contrary to my belief, it's possible to have a social life while on the LID! On Saturday, Emily and I went to Rosenthal Wine in Malibu to celebrate her cousin's birthday. And then, after that, we went to the Hollywood Bowl for the Tchaikovsky Fireworks Spectacular, with conductor Gustavo Dudamel, the LA Philharmonic, and special guest the USC Trojan Marching band! If you look closely at the photo below, you can see the marching band lined up around the front of the stage.
The fireworks rise to wake up those who fell asleep to the classic music.
So now, in week 2 of the LID, I have to start getting ready for the 50 mCi radioactive iodine dosage, which I'll be receiving on Friday, July 31st. And fortunately, because it is the standard within the UCLA Health system (which my endocrinologist is a part of), I will be receiving Thyrogen injections in preparation for the dose.
What is Thyrogen? Allow me to explain...
My blog is not sponsored, I swear.
For decades, the standard RAI (Radioactive Iodine) treatment went like this: for about 6 weeks prior to receiving the RAI dose, a person would have to completely stop taking their synthetic thyroid medication. In some cases, people would be prescribed a different medication (Cytomel - T3), which would help soften the blow of withdrawing from the hormones, but even then, they'd have to fully withdraw for that right before the RAI.
As the weeks progressed, patients would experience the symptoms of hypothyroidism, which would get worse and worse over time. The thyroid controls the body's metabolism. Without its hormones, a person's metabolism basically shuts down. The bottom line is that food no longer gets converted into energy; it just gets stored as fat.
The symptoms of hypothyroidism include: fatigue, increased sensitivity to cold, constipation, dry skin, unexplained weight gain, puffy face, hoarseness, muscle weakness, elevated blood cholesterol level, irregular menstrual periods, muscle aches, joint pain, thinning hair, slowed heart rate, and depression.
The symptoms of hypothyroidism include: fatigue, increased sensitivity to cold, constipation, dry skin, unexplained weight gain, puffy face, hoarseness, muscle weakness, elevated blood cholesterol level, irregular menstrual periods, muscle aches, joint pain, thinning hair, slowed heart rate, and depression.
Jackie, please don't even try to fathom hypothyroidism.
But what was the point of all this suffering? Did endocrinologists just like making thyroid cancer patients squirm?
Well I can't speak for all endocrinologists, but I'm sure for most the answer is no. The reason is simple(ish). Withdrawing from thyroid hormones causes Thyroid Stimulating Hormone (TSH) levels in your blood to increase.
Wait, what is TSH you ask? Well I'm about to get biological on yo' ass.
That sounded weird. But I'm still going to do it.
It all starts with your pituitary gland, aka "The Master Gland," according to nerdy medical types. The pituitary gland releases TSH within a sort of negative feedback loop. If it can't detect enough thyroid hormone in the blood, then it releases TSH as a sort of call to action to all thyroid cells in the body, as a signal to take whatever iodine it has and convert it into thyroid hormone (T4). TSH does nothing for the body in and of itself, other than "wake up" thyroid cells.
Because I've been taking levothyroxine this whole time, that means my pituitary gland has been tricked into thinking my non-existent thyroid is producing enough thyroid hormone to keep my body going.
So back to what started this whole conversation: why elevate TSH? Well, when you take the radioactive iodine dose, you want any remaining thyroid cells in your body to take it in ASAP. Having starved them of iodine for 2 weeks on the LID, having increased TSH in your blood is yet another (and the most important) thing that will signal to your thyroid cells that they need to start working overtime.
Following this logic, the best way to raise TSH in your blood is take the blindfold off your pituitary gland, make it realize that you are severely deficient in thyroid hormone, and therefore cause it to desperately release TSH into the blood.
Going hypothyroid, or going through "Hypo Hell," as many people call it, was the way to do this. Until Thyrogen came out.
Because I've been taking levothyroxine this whole time, that means my pituitary gland has been tricked into thinking my non-existent thyroid is producing enough thyroid hormone to keep my body going.
So back to what started this whole conversation: why elevate TSH? Well, when you take the radioactive iodine dose, you want any remaining thyroid cells in your body to take it in ASAP. Having starved them of iodine for 2 weeks on the LID, having increased TSH in your blood is yet another (and the most important) thing that will signal to your thyroid cells that they need to start working overtime.
Following this logic, the best way to raise TSH in your blood is take the blindfold off your pituitary gland, make it realize that you are severely deficient in thyroid hormone, and therefore cause it to desperately release TSH into the blood.
Going hypothyroid, or going through "Hypo Hell," as many people call it, was the way to do this. Until Thyrogen came out.
The sweet, sweet nectar (brought to you by the Genzyme Corporation)
Excelsior!
Although it had been used in Europe for years prior, the US FDA approved Thyrogen for use domestically in late 2007. Once it was in use, there were shortage problems as recently as 2011, but it now appears to be in adequate supply for mainstream use. Thyrogen synthetically raises TSH to levels necessary prior to RAI treatment, meaning the patient does not have to withdraw from thyroid hormones. HOLLAH!!!
Captain Jean-Luc Picard loves thyrotrpin alfa.
Thyrogen is administered through a series of injections on consecutive days. On Day 1, you get your first injection. On Day 2, you get your second injection. And then on Day 3, you receive your RAI dosage. All of this has to happen consecutively. In the butt. Yes, you heard me right; the injection occurs on your buttocks.
That's all I have to say about that.
You know what, if getting shot in the buttocks means I don't have to withdraw from my medication, then I'll take it!
That's more like it, Oprah.
So that's what I have to look forward to. I'll be off of work again starting this Wednesday, the first day of Thyrogen injections. That'll give me time to get ready for my week of isolation. Since I have to continue the LID for 2 days after my RAI treatment, I have to make sure I go to my parents' house stocked with low-iodine food to last me through the weekend. Plus, I just have to take care of stuff logistically, since I'll be locked away in my room for a week and away from real life.
Excelsior!
-W
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