Patient Bulletins

The Graves’ Disease and Thyroid Foundation has posted informational “Bulletins” on Graves’ disease to our website.
These bulletins cover several areas of concern that are beneficial to patients and family members. The bulletins are in pdf form so they're printable from your home computer. If you have any suggestions on topics you would like information on, send us a message in the Contact Us section of our website.

Bulletin Number


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Graves’ Disease and Pregnancy Planning – 2010

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Graves’ Disease and Pregnancy – 2010

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Graves’ patients & Non-prescription drugs

Norman Tomaka, C.R.Ph.

An acute symptom is one that comes on suddenly. Acute problems, such as a headache, postnasal drip, or muscular pain due to exercise, often are not serious conditions, and may be treated with a properly chosen over-the-counter medication. Remember, however, that selfmedication may be challenging if a patient is taking prescription or nonprescription medication. Drug-with-drug interactions are a major reason for complications. When taking thyroid supplements, high-blood-pressure medications, etc., it is always best to consult your doctor or pharmacist before using any other medication. What seems like a simple and safe product for a headache might cause a significant and dangerous combination with some prescription medications. If acute symptoms continue, despite supportive therapies like proper over-thecounter medication, rest (where necessary) and time, a symptom becomes chronic. Chronic problems usually indicate the need for skilled diagnosis that a physician provides. Simply put, if a problem persists, do not continue to self medicate, see your doctor.

How to Choose the Correct Over-The-Counter Product

Many potent and effective medications are currently available over the counter and it is difficult to choose the correct product. The market for such products is lucrative and advertising and marketing specialists sell the “name” of a product, often at a cost disadvantage. Many medications are the same as others but, in some other cases, products have a similar name but contain entirely different medications. Examples include Tylenol® Cold and Sinus Vs Tylenol®, or Mylanta® Vs Mylanta®-AR. Because names and product commercials can be misleading, consult with your pharmacist when in doubt about a medicine. Do not simply match the product’s listed “cures” with a specific symptom.

The following factors should be considered when choosing self-medicating products for specific symptoms.

  • Pain and Fever
  • Anti-inflammatory products
  • acetaminophen

Many medications available over the counter are able to reduce swelling (inflammation) and pain. Examples include ibuprofen (Motrin®-IB, Advil®, Nuprin®), naproxen sodium (Aleve®), ketoprofen (Orudis®-KT) and aspirin or acelasalicylic acid (Bayer®). Anti-inflammatory products are effective in reducing joint and muscular pain and the associated swelling. They are also excellent choices for arthritic pain and swelling. However, these products should not be used by gastrointestinal ulcer patents, heart or kidney patients, without the physician’s authorization. Also, patients having asthma or allergic reactions to any one of the anti-inflammatories may not safely use any without their doctor’s advice. While the labels on these products address these concerns, they are sometimes ignored or forgotten. The fact that a product can be sold without a prescription does not imply that everyone can safely use it. Your pharmacist knows for sure.

Acetaminophen (Tylenol®) is the most widely used over-the-counter medication in America. Most patients can safely use this medication for pain or fever. While not an effective anti-inflammatory medicine, many arthritic sufferers use acetaminophen to manage pain. Like all over-the-counter products, acetaminophen may present a health risk for some patients. Patients with liver disease, alcoholism or certain immune disorders should not use acetaminophen without doctor’s approval. Recently, acetaminophen use has been shown to be possibly hazardous to people having one or more alcoholic beverages daily. If you have any doubt, ask your pharmacist, even about a medication often thought of as a simple and safe universal choice for pain.

Cough Medications

  • expectorant vs. suppressant
  • combination products

Depending on the symptom and other medications used, the choice of a cough medication can make a significant difference in effectiveness. Patients with bronchial mucous should refrain from suppressing a cough. In this case, plain expectorants are preferred to help clear the lungs of bothersome mucous. Often, what is thought to be a simple cough syrup is actually a combination of other symptom relievers. Decongestants, pain relievers and alcohol are often included in some cough formulas. How can someone tell if the cough medicine is right for him or her? Ask your pharmacist. Remember that if you are taking certain prescription medications, it may be dangerous to use nasal decongestants, cough suppressants, pain relievers and alcohol. All cough medicines are not alike.

Sinus Therapy Medications

  • antihistamines
  • decongestants
  • mucolytics
  • combination products

Whether allergy or head cold, sinus symptoms can be most aggravating for many. Seasonal allergies, postnasal drip or nasal congestion are sometimes easily controlled with the proper over-the-counter sinus medication. However, many products compete for the sinus sufferer’s selection. Many products present a risk to thyroid patients. Nasal decongestants, used to reduce nasal stuffiness can increase blood pressure and heart rate. Examples include pseudoephedrine, phenylephrine and phenylpropanolamine. A sometimes very dangerous combination is presented if a patient is taking a thyroid supplement. Antihistamines like diphenhydramine, chlorpheniramine, brompheniramine and clemastine used to reduce mucous production and other symptoms associated with allergies can be a safe choice for one patient, but a dangerous choice for someone suffering from glaucoma. Patients suffering from the common cold should sometimes avoid antihistamines. Drying mucous membranes with antihistamines is believed to increase the duration of cold symptoms. It is often a better choice to use a mucolytic product (a medication that thins mucous or phlegm) than a decongestant or antihistamine. Your pharmacist will assist you in choosing the best medicine for your specific needs.

External Pain Relief Medications

  • camphor/menthol rubs
  • the role of aloe vera
  • methylsalicylate
  • heat vs. cold therapy

Many of us suffer from simple, but annoying, aches and pains. From the commercials of late, it is easy to be misled into believing that external products cure problems like arthritis. There are many choices for external rubs. Some use camphor and/or menthol. These products are effective in producing “heat” to help relieve pulled muscle pain. However, these products may sometimes irritate the skin of patients using oral medications that dry the skin. Sometimes, an external pain reducer like methysalicylate may be more effective. Aloe vera, a popular and effective natural product, is often included in rubs to help improve the massaging action beneficial to muscular pain. Some circumstances may necessitate the application of heat (tight muscles) or cold (swollen joints), rather than the use of a rub. Ask your pharmacist which therapy is best for your aches and pains. It may make a significant difference in how you feel and how many dollars you spend.

External Anti-infectives

  • Alcohol
  • iodine products
  • hydrogen peroxide
  • antibiotic ointments
  • bacitracin, neomycin, polymixin
  • combination products

More than any other first aid product, externally applied anti-infective agents can prevent a small cut or bruise from becoming a major health hazard. Many choices exist to control infection of the skin. Products to cleanse the skin often include an anti-infective with soap. Ointments and creams for cuts and scrapes can include one or more anti-infectives with external pain relievers. Some wounds are deep and would be best handled by a physician. When you are not sure, check with your pharmacist. For infection prevention, liquid non-stinging iodine {a purple liquid povidone iodine) is often the best choice for initial application unless a patient is allergic to iodine. Hydrogen peroxide 3% is often a good alternative to iodine for some areas of the body, while inappropriate for other areas, such as the ear. Alcohol is usually not a good choice for direct application to injured skin. Some wounds require a bandage, while some injuries are best left exposed to air. Others would be best treated with neomycin and bacitracin in ointment or cream form. Fresh, surgical wounds are usually best treated with polymixin and bacitracin because neomycin may be irritating. Simple stings and bruises respond best to external pain relief from topical anesthetics like benzocaine or lidocaine. Sometimes, however, it is best to avoid such anesthetics because they reduce infection protection and/or may cause irritation to deeper cuts and scrapes.

Graves’ disease patients often suffer from dry skin. Despite proper thyroid supplementation and desirable thyroid levels, dry skin seems to bother the Graves’ patient from one time to another. As a rule, thyroid patients should spend a little extra time preventing skin irritations by using emollients. Hypoallergenic (reduced potential for skin allergy) products are those most preferred for moisturizers. Your pharmacist can provide information as to which external product may be best for your type of skin.

Other External Products

  • anti-fungals
  • dry skin therapy
  • anti-pruritic [itch] products
  • acne products
  • oily skin and hair products

Recently, many affective medications have become available over the counter for use in fungal infections. Clotrimazole and miconazole represent the most effective treatments available over the counter to kill fungal infections such as athlete’s feet, vaginal yeast or ringworm. However, many people misdiagrial or noninfectious dermatitis. Sometimes the itch may indicate a fungus is present. Hydrocortisone creams and ointments are effective for itchy and dry skin, or for skin allergic reactions, but a poor choice for fungal infections like athlete’s feet. In other cases, the skin may simply be dry and require an emollient or moisturizer to help improve skin condition. Acne, however, usually requires drying agents to help reduce oily skin known to foster bacteria and cause unsightly blemishes. Most important to emphasize is, when improvement does not occur (chronic condition), see your doctor or pharmacist. Skin is a significant organ of the body.

Dental Products

  • gum injury products
  • oral mucosal tissue
  • treatment
  • tooth pain remedies
  • lip products
  • preventive hygiene

Dental condition is often a good indicator of a patient’s overall health. Many products exist for relief from simple mouth ulcers and gum abrasions. However, some dental conditions require the attention of your doctor or dentist. Mouth ulcers that do not quickly heal, for example, may indicate a vitamin deficiency or a more serious condition. Warm saltwater rinses may be the best choice for some gum irritations, hydrogen peroxide and or baking soda for others. While many effective products are available for the patient to use, pharmaceutical advice may sometimes be an important choice in selecting such products. Dentists often advise patients to spend a time preventing dental problems. A little time with your pharmacist may help in choosing the best oral product from fluoride rinse for lip protection to gum treatments using carbamide peroxide.

Used with permission of the author.

Norman Tomaka is a community pharmacist and has an active independent consulting pharmacy practice. He is licensed both in Florida and New York as a registered pharmacist, and a Florida Certified Consultant Pharmacist. He has 19 years in the pharmacy profession.

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