Ken's Story

Back in the '70s, Ken, a college professor, who had always suffered with allergy problems, couldn't shake a persistent sore throat.

I had a really bad sore throat for a very long time, and [my internist] couldn't figure out anything causing it. Throat cultures turned out negative. I found myself getting very emotional about it. I was also very tired and tripping over things all the time. Finally, some­one suggested that I see an ENT [ear, nose, and throat doctor], and that's what I did.

Ken's parents reminded him that he had radiation of his thymus when he was a child, and, after watching a television show about the impact of early radiation on babies and young children, they were concerned that he might be at an increased risk for thyroid cancer. Ken mentioned his history to his ENT who ordered a thyroid scan.

I went for the scan; it was a two-day procedure. I remember sitting in the waiting area with the other patients on the second day. They dismissed everybody but me! Finally, a doctor saw me and said that there were no signs of cancer but that my thyroid was three times larger than a normal thyroid. I had thyroiditis, and it had reduced my thyroid [hormone] levels.

They gave me a small amount of [levothyroxine]. There was such a dramatic difference very quickly. I had more energy and was getting so much done at work that my secretary threatened to flush my thyroid pills down the toilet.

After a year, I got off thyroid medication. But then they found out that my thyroid levels were still low. They kept increasing the dosage [of levothyroxine]. I thought something was really wrong since I had to take so much thyroid [hormone].

Then I started getting sick a lot. I had zero resistance. Almost every month, I got sick with a viral infection of some sort. I was having the symptoms of hypo­thyroidism. I went to an endocrinologist. My TSH [thyroid-stimulating hormone] level was very high. Basically, I had no thyroid function. He didn't under­stand how I could even function.

He went through all the things I did. I was taking Metamucil and Per Diem [psyllium] every day. He said that they were interfering with the absorption of my thyroid medicine. He told me not to take any of these laxatives within two hours of taking my thyroid medicine.

In addition, his endocrinologist became concerned when he learned about Ken's history of radiation to his thymus as a child.

He suggested surgery because he was so worried about the thymus x-rays. He sent me for an ultrasound, and [the technician] thought she saw something. I decided to get a second opinion. I went to [another endo­crinologist], and he redid the ultrasound and never saw anything. He said I didn't need an operation, and I walked out of there very happy.

When Ken went to the second endocrinologist, he took a copy of his previous laboratory results with him. They confirmed that he had Hashimoto's thyroiditis.

I switched to [another brand-name levothyroxine] that was absorbed better and take bulk laxatives now only in the evening.

Another secondary problem I had [when I was hypothyroid] was that I had fallen in love and had no sexual function. Getting my thyroid level fixed helped that.

Like many other patients, Ken's thyroid disease is not an isolated incident in his family.

My dad had hyperthyroidism and took the iodine cocktail. My wife also takes thyroid [hormone], and I suggested that she get it checked.

Because he had seen a physician and took his levothyroxine as prescribed, Ken assumed thyroid dysfunction could not be the source of his fatigue and diminished sex drive. He was unaware that certain substances, such as laxatives, can interfere with levothyroxine absorption, resulting in inadequately treated hypothyroidism.

Just knowing you have a thyroid problem is not enough. I didn't understand something else I was doing was affecting it. It was a surprise to me because I didn't dream it was a thyroid problem because I was taking my thyroid [medication].

Taking levothyroxine on an empty stomach, with water only, prevents some unpleasant and unanticipated consequences and ensures that your medicine is completely absorbed. Patients should not take anything else, including over-the-counter supplements and natural products, with their levothyroxine.