Barretts Esophagus and Thyroid problems.

[Claytonjean]

Not very knowledgable about medical issues. Been taking Levithyroxine for 20 years. Diagnosed with Barretts Esophagus in Oct 16. Also diagnosed at same time with H. Pylori. Treated immediately with strong antibiotics for H.Pylori. Not told that Levithyroxine and Omerprazole should not be taken together. I have since read that information. Now after 20 years of underactive thyroid I now have an overactive thyroid (hyperthyroid) with a TSH of 0.07 which I guess could be caused by taking Omerprazole 40 at same time as my Levithyroxine 100. I have palpitations, anxiety, lost 22lbs, irritability and depression. I have been off my thyroid meds for a week and now told to restart with Levithyroxine 88. I am still having palpitations but am not so anxious etc. I am concerned now, as I have read if you have thyroid issues normally stomach acid is low. I am taking Omerprazole to reduce stomach acid also. How is this affecting me? I don't know if I don't feel good due to Barretts, thyroxine issues or Omerprazole. Prior to my Gastroscopy I had occasional heartburn, no reflux and felt well. My BE gastroscopy was ?1cm Barretts with no sign of anything else, linked to stress which was over-riding factor. I feel my life has changed big time and not confident my meds or my problem are being managed correctly. Where do I go from here as so many conflicting reports. Will add since my BE diagnosis I have changed my diet big time and do not eat anything I am told I shouldn't. Sorry by mistake I have removed Thyroid problems from tag list.

[Clutter]

Claytonjean,

TSH 0.07 doesn't mean you were hyperthyroid but as you don't have results for FT4 and FT3 there's no way to tell. Your symptoms could be due to over medication or they could be due to HPylori or Barretts. Taking Levothyroxine with Omeprazole is likely to reduce Levothyroxine absorption not increase it. Still, best practice is to take Levothyroxine with water 1 hour before, or 2 hours after, food and drink, 2 hours away from other medication and supplements, and 4 hours away from calcium, iron, vitamin D supplements, magnesium and oestrogen.

Stomach acid is usually low in hypothyroid patients but that doesn't mean it is always low. As you have Barretts you are prescribed Omeprazole to protect your oesophagus against acid which can cause cancer when left untreated.

[helvella Administrator Thyroid UK]

Claytonjean,

There is every reason to think that there is a connection between reflux and hypothyroidism. Hence, with Barrett's oesophagus.

I have posted the abstracts of three papers - the first two being fairly straightforward.

Despite these, and a few other papers, established medicine seems frequently not just to miss or ignore the link but to positively deny that any such link exists. Otherwise I wouldn't have gone back to 1982 for that first paper.

And you really do need to get hold of test results and post them.

J Clin Gastroenterol. 1982 Aug;4(4):307-10.

Reversal of lower esophageal sphincter hypotension and esophageal aperistalsis after treatment for hypothyroidism.

Eastwood GL, Braverman LE, White EM, Vander Salm TJ.

Abstract

A 65-year-old woman suffered from both chronic gastroesophageal reflux, which was complicated by columnar metaplasia (Barrett's epithelium), and profound hypothyroidism. An esophageal motility tracing showed absence of peristalsis in the lower esophagus and the lower esophageal sphincter (LES) could not be identified. Thyroid replacement therapy, in conjunction with antacid and cimetidine treatment, was associated not only with improvement in the gastroesophageal reflux symptoms, but also with a return of esophageal peristalsis and LES pressure to normal. To support our clinical observations, we rendered four cats hypothyroid with 131I and documented a fall in LES pressure. We propose that abnormal smooth-muscle function of the esophagus may be another manifestation of the gastrointestinal motility disturbances which are associated with hypothyroidism.

PMID: 7119407

ncbi.nlm.nih.gov/pubmed/711...

Klin Med (Mosk). 2006;84(2):71-4.

[Hiatus hernia and gastroesophageal reflux disease as a manifestation of a newly revealed hypothyroidism].

[Article in Russian]

Savina LV, Semenikhina TM, Korochanskaia NV, Klitinskaia IS, Iakovenko MS.

Abstract

The aim of the study was to reveal hypothyroidism (HT) in patients with hiatus hernia (HH), treated at Russian Centre of Functional Surgical Gastroenterology. The subjects were 64 women: 18--with HH and diffuse or diffuse nodular goiter, 36--with HH, and 10--without endocrine or somatic disease background. The examination included the evaluation of the thyroid and metabolic status, endoscopy, and 24-hour ph-metry. The results show that one of the early signs of HT is HH and gastroesophageal reflux disease. The latter in HT patients is associated with gastrointestinal motor-evacuatory disturbances rather than with acid exposition in the distal esophagus.

PMID: 16613012

ncbi.nlm.nih.gov/pubmed/166...

BMC Cancer. 2007 Jan 10;7:5.

Expression of the Na+/I- symporter (NIS) is markedly decreased or absent in gastric cancer and intestinal metaplastic mucosa of Barrett esophagus.

Altorjay A1, Dohán O, Szilágyi A, Paroder M, Wapnir IL, Carrasco N.

Author information

1 Department of Surgery, St. George University Teaching Hospital H-8000 Székesfehérvár, Hungary. [e-mail] <[e-mail]>

Abstract

BACKGROUND:

The sodium/iodide symporter (NIS) is a plasma membrane glycoprotein that mediates iodide (I-) transport in the thyroid, lactating breast, salivary glands, and stomach. Whereas NIS expression and regulation have been extensively investigated in healthy and neoplastic thyroid and breast tissues, little is known about NIS expression and function along the healthy and diseased gastrointestinal tract.

METHODS:

Thus, we investigated NIS expression by immunohistochemical analysis in 155 gastrointestinal tissue samples and by immunoblot analysis in 17 gastric tumors from 83 patients.

RESULTS:

Regarding the healthy Gl tract, we observed NIS expression exclusively in the basolateral region of the gastric mucin-producing epithelial cells. In gastritis, positive NIS staining was observed in these cells both in the presence and absence of Helicobacter pylori. Significantly, NIS expression was absent in gastric cancer, independently of its histological type. Only focal faint NIS expression was detected in the direct vicinity of gastric tumors, i.e., in the histologically intact mucosa, the expression becoming gradually stronger and linear farther away from the tumor. Barrett mucosa with junctional and fundic-type columnar metaplasia displayed positive NIS staining, whereas Barrett mucosa with intestinal metaplasia was negative. NIS staining was also absent in intestinalized gastric polyps.

CONCLUSION:

That NIS expression is markedly decreased or absent in case of intestinalization or malignant transformation of the gastric mucosa suggests that NIS may prove to be a significant tumor marker in the diagnosis and prognosis of gastric malignancies and also precancerous lesions such as Barrett mucosa, thus extending the medical significance of NIS beyond thyroid disease.

PMID: 17214887

PMCID: PMC1794416

DOI: 10.1186/1471-2407-7-5

ncbi.nlm.nih.gov/pubmed/172...

[Claytonjean in reply to helvella]

Thank you. I will not have T4 free for 4 weeks as doc wants me to take 88 Levothyroxine daily until that time, starting yesterday.

[Daffers123]

the symptoms you list happened to me when I became over medicated. I investigated whether weight loss meant I needed less thyroxine...and I did. Like you i stopped Levo for few days and then started back on lower dose. Things settled down - thankfully as anxiety/irritability/palps very unpleasant. I have found it tricky to stabilise my dose (or perhaps I am just more aware of symptoms) probably because I do have Hashimotos. have your antibodies been tested ?

[Claytonjean]

No no more tests until I have been on reduced meds for 4 weeks.

[penny]

Interesting. My brother has BE (two heart attacks) and is now on masses of medication including statins. Unfortunately he is a devoted follower of his GP with no questions asked - I have mentioned CoQ10 and Vit D before and given him The Great Cholesterol Con, to no avail. I must now add BE and hypothyroidism. This site is a fount of knowledge.

[sja11]

Have you been retested for helicobacter pylori? It can cause really bad acid reflux and blocks vitamin uptake.

It took me 4 years to get rid of it. Many different strong antibiotics didn't work

Antibiotics only have a 70% success rate. In the end I used Nigella (black) seeds and very high dose probiotics.

[Claytonjean]

No I haven't! I did ask my doctor if they were going to test to see if I was clear. They said it wasn't necessary!

[Jessmac77 in reply to Claytonjean]

I have h.pylori and barretts.false negatives are common and retesting is essential. There are many strains and many of them are antibiotic resistant