Besides managing obvious thyrotoxicosis, beta-blockers have additional benefits in people with thyroid cancer. Unlike people with hypothyroidism, taking sufficient thyroid hormone to provide normal TSH levels (see Chapter 2), those with thyroid cancer take a slightly higher daily levothyroxine dosage, sufficient to suppress the TSH to levels less than 0.1 (see Chapter 9). In most, this doesn't cause any thyrotoxic symptoms, but in around one-third of such people (including Sara), this causes a rapid resting pulse rate (greater than 80 beats per minute), a sensation of palpitations, or some difficulty getting to sleep. If this happens, a once daily beta-blocker (particularly one that is beta-1-selective) makes these symptoms disappear. It also prevents any potential effects of this dosage of thyroid hormone on thickening the left ventricle heart muscle. (See Chapter 25.)
Beta-blockers are also effective medications to treat high blood pressure, prevent angina or heart attacks in people with cardiovascular disease, reduce the frequency of migraine headaches, and prevent panic attacks. This makes their appropriate use, in thyroid cancer patients, multifunctional. Sara has told me that her beta-blocker has also eliminated her panic attacks and feelings of jitteriness after eating (which she had wrongly attributed to hypoglycemia). In this context, the beta-blocker nicely balances the thyroid hormone suppression therapy (to keep TSH low) that is a mainstay of thyroid cancer treatment.
Stable iodine (or, more accurately, as its salt, iodide) means nonradioactive iodine, which is added to salt and vitamins as a dietary supplement; the addition of iodine to
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