Many thyroid cancer patients are more or less confused as to why they should take Eugenol for a long time after thyroid cancer surgery, whether there are any toxic side effects of taking it for a long time, whether they need to stop taking Eugenol during pregnancy, and so on.
A few terms.
Before answering this question, several basic medical questions need to be explained, which may have some technical terms.
1. Thyroid gland and thyroid hormone: The thyroid gland is an essential organ of the human body, from fetus to old age. The main function of the thyroid gland is to produce thyroid hormones. The function of thyroid hormones is to promote human development and regulate the metabolism of many substances in the body, etc. If there is not enough thyroid hormone, the fetus will be deformed, stop developing and miscarry; in adults, various diseases of slow metabolism will appear: such as hyperlipidemia, edema, poor energy, and even depression of various degrees. If there is too much thyroid hormone, the condition of high metabolism (commonly known as “hyperthyroidism”) will also occur, such as weight loss, high energy, insomnia, irritability, fast heartbeat, and even osteoporosis.
2, levothyroxine tablets and euthyroxine: levothyroxine is a synthetic thyroxine (the main component is the sodium salt of tetraiodothyronine, L-T4). It can be easily absorbed and utilized by humans, and produces effects similar to those of human thyroid hormones, which means that it can replace lost or missing thyroid hormones. Eugenol is one of the most commonly used synthetic levothyroid hormones. It is a levothyroxine sodium tablet manufactured by Merck in Germany. Euthyroxine refers to Merck’s levothyroxine sodium tablets. Besides Euthyroxine, there are other levothyroxine sodium tablets at home and abroad, such as Retisol, Voltarenol, and Gahon.
3.Differentiated thyroid cancer (DTC for short): When differentiated thyroid cancer occurs, the cancer cells have some thyroid functions, such as the function of synthesizing thyroid hormone, and are also affected by the regulation of human hormones. The two common types of differentiated thyroid cancer are papillary and follicular.
4. Neuro-endocrine axis: The hormone secretion of human body is regulated so as not to produce too much or too little. This regulation requires the structure of the human brain to regulate. When hormones are not produced enough, the human brain sends signals (such as thyroid stimulating hormone, or TSH for short) to keep endocrine organs such as the thyroid gland active, resulting in an increase in the number of thyroid cells and active function.
Why should I take thyroid hormone for a long time?
Patients with differentiated thyroid cancer usually have their thyroid gland removed (all of it or a small part of it is preserved). After removal, the overall quantity and quality of the thyroid gland is significantly reduced, which in turn reduces the function of the thyroid gland and leaves the body deficient in thyroid hormones. In order to maintain the body’s daily needs, additional synthetic thyroid hormones must be supplemented daily to compensate for the lack of thyroid hormone production.
Therefore, patients with post-operative thyroid cancer must take thyroid hormones for a long time.
In addition, the cancer cells of differentiated thyroid cancer have certain functions of thyroid cells, if the human body has sufficient or even excessive thyroid hormone, the residual thyroid cells or cancer cells will be functionally inhibited and “don’t need to work”, and finally, the tumor cells will gradually atrophy if they “work negatively”. In the end, tumor cells will gradually shrink if they are “idle” in this way, thus achieving the purpose of treatment and prevention of tumor recurrence. In medical terms, it is called TSH suppression therapy.
Dosage and administration of levothyroxine (Eugenol).
According to the above, patients after thyroid cancer surgery must be required to take sufficient amount of thyroxine for a long time. How much should be taken?
There is an international recommendation. However, it should be noted that each person has a different efficiency in absorbing and utilizing the drug, and their body size is different. There will be some differences in the dosage required for each person. Therefore, not everyone is taking 2 tablets of Eugenol, some people need 1.5 tablets, some people need 3 tablets. This is like a different amount of food for each person, so there is no need to make a fuss.
For individual patients, the L-T4 dose of suppressive therapy is the dose needed to achieve their TSH suppression goal. In patients with DTC who have cleared all of their thyroid, the L-T4 dose for suppression therapy is usually higher than the replacement dose alone, averaging about 1.5 to 2.5 μg/kg/d. In older patients (especially those over 80 years of age), the L-T4 dose to achieve TSH suppression is 20% to 30% lower than in younger patients because the reduction in peripheral degradation of thyroid hormone in the elderly is greater than the reduction in oral absorption. decreases. It is important to listen to a thyroid disease specialist for the exact dosage and not to compare patients with each other. Because each patient’s situation is different, doctors need to make a comprehensive judgment. This is the emphasis in medicine today on individualized treatment.
The optimal goal value of TSH suppression therapy should meet: to reduce the recurrence and metastasis rates and related mortality of DTC, but also to reduce the side effects and improve the quality of life caused by exogenous subclinical hyperthyroidism. To date, there is no consensus on this optimal target value.
How is the L-T4 dose adjusted?
It is generally recommended that TSH be measured every 4 weeks or so, and that thyroid function be rechecked every 2-3 months for 1 year, every 3-6 months for 2 years, and every 6-12 months for 5 years after achieving the target to determine that TSH is maintained in the target range.
Dosage: L-T4 is most beneficial for maintaining stable TSH levels when taken on an empty stomach before breakfast. In case of missed doses, double the dose should be taken until the entire missed dose is made up; or supplement appropriately according to your individual situation. Some patients need to adjust L-T4 dosage according to the change of TSH level in winter and summer (increase in winter and decrease in summer).
It is important not to stop the medication blindly during pregnancy.
Adverse effects and side effects of thyroxine.
In theory, levothyroxine (L-T4) such as euthyroxine is free of adverse reactions and toxic side effects. This is because it is a substitute for a substance – hormone – that is already present in the body. Most of its toxic side effects and adverse reactions are due to the clinical symptoms of hyperthyroidism (commonly known as “hyperthyroidism”) caused by overdose or large dose adjustment, including: tachycardia, palpitations, arrhythmia, angina, headache, muscle weakness and spasm, flushing, fever, vomiting, menstrual disorders, pseudocephaly, tremor, restlessness, insomnia, and sleeplessness. , fidgeting, insomnia, excessive sweating, weight loss and diarrhea. In these cases, the daily dose should be reduced or stopped for a few days as ordered by the doctor. Then, the medication regimen should be readjusted.
As for L-T4 allergy, it is extremely rare. If it is indeed an allergy to Eugenol or other similar medications, you can switch to other similar medications from different manufacturers.
Medication for Pregnant, Pregnant and Lactating Women.
Eugenol must be taken during pregnancy! Because pregnant women have low thyroid function, they cannot ensure not only their own needs, but also the needs of the developing fetus. Because at this time, the thyroid gland of the fetus is not fully developed, especially in early pregnancy. Therefore, it is necessary to take sufficient doses of thyroid hormone and increase the dosage of thyroid hormone appropriately to ensure the needs of the pregnant woman and the fetus. This is the time to always consult an experienced thyroid doctor and obstetrician-gynecologist, and never take matters into your own hands!
Special care needs to be taken to continue treatment with thyroid hormones during breastfeeding. This is essential for mothers who have had their thyroid gland removed to maintain themselves. The breast milk of a mother who has taken thyroid hormones such as eugenol is normal breast milk.