Not a Loser

May 16, 2009 4:13 AM

GlandFilter: My SO has a problem. She has numerous symptoms of thyroid imbalance, but she shows up on tests as normal. Now she's trying to lose weight.

Basically, she's been exercising regularly and trying the low-carb diet. Absolutely no refined sugars, some carbs (i.e. fruit, mostly) along with lots of fiber and water. Eating several meals spaced out through the day. She's been keeping a food diary; 1200 calories per day. After four weeks, she has lost... nothing. She's currently two pounds under her starting weight; last week she actually went above it slightly.

In addition to the apparently stubborn excess weight (which appeared inexplicably several years ago, without any change in eating/activity habits, and has lingered since), she also has a family history of thyroid issues (mother and grandmother), a personal history of depression and anxiety (which didn't respond well to drug treatment), disrupted sleeping patterns, is always cold (to the point where she's running a space heater when I'm actively sweating and turning on a fan), and has unexplained fatty deposits in odd places like the back of her neck. However, blood tests for hypothyroidism came back "low normal." So my question here is twofold:

1) Does anyone know of a good way to lose weight under these conditions? Anything we're not already trying, that is?

2) Is there any other medical diagnosis that would explain sudden weight gain of this kind? Alternately, is there any way to get treatment for hypothyroidism if you're a textbook case but your scores aren't in the official "abnormal" range?

posted by Scattercat to health & fitness (23 answers total)

It sounds like she might actually be eating too little, thus throwing her metabolism into "hold on to every ounce of everything" aka starvation mode. Combined with regular workouts, that calorie count is pretty low, and definitely should be a bit higher.

I've used SparkPeople fairly successfully in the past; it will do full-out meal and exercise planning, or let you choose your own foods and workouts, or mix and match. There's also a built-in support system that comes in handy when things get rough. And best of all, all of it is free.

SparkPeople also makes sure you're trying to get at least 8 (8-oz) glasses of water a day and will track nutrients within the foods you're eating, making sure you're getting enough fiber and protein and just about anything else you can think of. If she's getting a lot of sodium, some of the problem may be water weight that isn't coming off.

Medically, I don't know of any reasons, as IANAD, but hopefully someone else will have some ideas along that vein... wish I could help more! Weight loss is hard enough without having to fight your body's chemistry for it.
posted by miratime at 4:23 AM on May 16, 2009

Alternately, is there any way to get treatment for hypothyroidism if you're a textbook case but your scores aren't in the official "abnormal" range?

I believe your SO is what's known as "sub-clinically hypothyroid," and sometimes some kind of treatment is still warranted. Has she spoken to an endocrinologist? If not, it's worth speaking to a specialist -- there are different types of thyroid problems and lots of people don't have conventional test results.
posted by foxy_hedgehog at 5:09 AM on May 16, 2009

Have her thyroid antibodies been tested? It is possible to have low-normal thyroid function and sky-high antibodies. (I was recently diagnosed with Hashimoto's under this exact scenario.) Also, thyroid levels fluctuate a great deal, and unless they are evaluated under current guidelines and by the same lab each time they may not be interpreted correctly. A family history combined with symptoms is very compelling evidence that something significant is going on and she should see an endocrinologist if she is still uncertain.

Regardless, 1200 calories is really skirting the edge of deprivation. After she gets retested it may be time to visit a nutritionist to determine what the best calorie intake/food types should be for her individual situation. If she is actually suffering from hypothyroid there are many foods that she'll have to limit, including normally healthy choices like soy and cruciferous vegetables. Even if she is otherwise healthy having some professional help with diet and exercise management couldn't hurt. Having a supportive partner is a tremendous help so it's great you are looking for ways to assist her. Best of luck finding a resolution.
posted by melissa may at 5:18 AM on May 16, 2009

My wife was mis-diagnosed as manic depressive and struggled for about 3 years with various drugs until one of her doctors finally put her on a low dosage of thyroid meds. It cleared up her symptoms.

She shows up as "low-normal" on thyroid tests and has a family history.

Consult with a doctor. If they insist there's no thyroid problem, find another doctor, or seek help from a specialist.
posted by Fleebnork at 5:41 AM on May 16, 2009

Even if she's spoken to an endocrinologist, it's worth trying another if she's got low-normal tests. Did she have her TSH tested? My T3 was low-normal but my TSH (thyroid stimulating hormone) was very high -- my body was working my thyroid overtime trying to get a normal amount of T3. My mom had the same thing, but hers went underdiagnosed for 30 years and she ended up having her thyroid removed because it had been destroyed by the overwork.
Also, some doctors use different reference ranges for low/normal/high, so it's entirely possible that another doctor would interpret her test results differently. It's definitely worth pushing to find a doctor who will take this seriously. If you want to post your location, someone could probably give a good recommendation for a doctor who treats aggressively.
posted by katemonster at 5:44 AM on May 16, 2009

Lot of thyroid posts lately. I'm just chiming in to say that her tests can be "normal" and she can still have thyroid problems. Last year, my preliminary tests were all in the normal range, but it turned out that I had thyroid cancer. Now that I've been treated and am on synthetic hormones, I feel much much better. Agreeing with the others to make sure she gets her TSH and thyroid antibodies checked.
posted by kimdog at 6:30 AM on May 16, 2009

If it's not the thyroid...

How old is your SO? It's possible the weight gain is related to slowing metabolism because of age. Yeah, it sucks. I think it's also possible that some lifestyle changes go unnoticed. When my now-husband and I started dating, I was just as active, but I also started eating a bit more because we ate meals together rather than the little snack-type meals I'd eat on my own. Also, is she really including everything in her food diary? Is there's something she's missing, like whole milk in her coffee?

Several years ago, when I first started what eventually became a long, slow weight loss, it took weeks to see the first pound or two drop. I started eating more sensibly, though I know I didn't go as low as 1200 calories--mostly I watched eating out and portion sizes. I also started exercising again, at first steep hikes and walks, and eventually some other stuff like exercise tapes and weight training at home and some running.

If your SO's exercise includes weight training, that's good, but it can mean she's losing fat and gaining muscle, which means she'll feel a bit different in her clothes, maybe, but won't see the drop in pounds.

Something else to take into account: a lot of women fluctuate weight up to five pounds or so over the course of a month, related to our periods. So, if she weighs herself at a lighter time, and then again at a heavier time, she might be losing weight overall but isn't seeing because of period bloat. During my weight loss year or two, I would often stay the same weight all month, and then, at the end of my period, all of a sudden (so it seemed) be two or three pounds less.

I know it sounds excruciatingly slow, but that's the deal sometimes. Especially if the changes she's making are lifestyle changes (good) rather than just temporary changes.

Is it possible that in her low-carb mode she's actually increased her fat intake too much? I found the best approach to healthy eating for me was making sure I ate enough vegetables every day. Once I ate enough vegetables, and fit the other food in around it, I was eating pretty healthy.

Also, how much overweight is she? I would suspect it'd take a long time to see results if she's trying to work off, say, five to ten pounds. But even if she's 30 pounds or more over her younger weight, it can still take ages to see the loss.

Finally, what sort of exercise is she doing? Weight training will help, even if it just involves small hand weights at home. Or else she might try stepping up the intensity a bit...

I say all this as someone who also has at times suspected my thyroid may be out of whack. Good luck.
posted by bluedaisy at 6:35 AM on May 16, 2009

I have similar issues. I think she should see her doctor. But in the meantime this works for me:

Tuesday - Friday I eat about 1600 calories a day but no simple carbs like bread or even rice or potatoes. Usually I have chicken or eggs, vegetables and seasoned black beans from a can. Half an apple for dessert.

I count the calories of absolutely everything that goes into my mouth.

I cannot have juice or alcohol on these days.

On Saturday I can have wine and I can have pasta or bread with my meals. I don't count calories on this day.

Sunday is like a weekday but I skip the last meal of the day and don't eat anything after about 3PM.

Monday I fast. No juice!

I avoid salty foods every day because the water retention makes me feel like I am not losing weight.

If I follow this plan I will lose 3lbs a week and I have the most stubborn metabolism on Earth. My thyroid tests normal but I have a lot of low thyroid symptoms.

I got the idea for this plan from the 4 day work week guy (Ferris sp?).
posted by cda at 6:53 AM on May 16, 2009 [3 favorites]

Responses from the SO (who was ironically the one who introduced me to MetaFilter but who has not yet gotten an account.)

---

Hi! This is the SO.

To address some of the suggestions that have come up in the thread -

I'm down to 1200 calories because I'm not a tremendously active person, and only eating 1400 calories a day was having no effect. I've also been making sure to drink a sufficient amount of water, and I've nearly cut Diet Coke out of my diet completely. I indulge now and again, but otherwise it's not a significant factor in terms of caffeine or anything else that would interfere with weight loss. I'm currently hovering between phases1 and 2 of the South Beach Diet, taking into account that I refuse to eat low-fat mayo (and adjusting accordingly) and haven't really introduced much back into my diet beyond fruit and the occasional piece of multigrain bread. We generally avoid processed food even when we aren't dieting - we're the sort of people who shop around the edges of the supermarket, with the exception of nuts - and I'm being careful not to overload on fats (but low-fat mayo is an abomination and I won't have it in the house.)

I'm also exercising. A few months ago (prior to being knocked out of my routine by a fairly nasty wisdom tooth extraction) I was working out for over an hour four or five times a week and eating roughly 1400 to 1600 calories a day. Sometimes a bit more, but nothing egregious. Kept this up for a while, and noticed no real changes except for stamina and a persistent pain in my planar fascia. I still use hand weights at home, go on long, brisk walks, and play DDR on a regular basis. Again, nothing, not even a change in the way my clothes fit.

As to my weight loss/gain history - I'm almost 28. I've always been a bit pudgy, despite being active, but nothing near where I am now. The women in my family have wide hips and are generally short and Reubenesque, so I didn't think much of it, and I carry weight well - small blessing, I guess. In '98-99, I suddenly lost about 20 pounds with no changes in diet or exercise. That was pretty awesome - it put me at what I would say my ideal weight is (~140ish, above the 120 or so that the BMI scale would recommend for a 5'2" person such as myself). I kept that off until my sophomore year in college. I would have expected some sort of gain freshman year, what with stress and lifestyle changes, but I actually continued to lose weight. Since then, I've been gaining an average of 15-20 pounds per year, despite my best efforts to step up exercise, eat well, and the like. Currently I'm hovering around 235.

Other issues that haven't come up yet, but have been mentioned previously: I've considered antidepressants and anti-anxiety medication, but I never stayed on that long enough for it to be at fault. I take birth control pills, and I've discussed possible side effects with doctors.

Oh, and doctors. Hrmph. It really doesn't help that I have a needle phobia... We're smack dab between Richmond and DC, and our endocrinologists are crap. There are two that I'm aware of; one refuses to take new patients, and the other was really, really surprised that I wasn't even at risk for diabetes according to the bloodwork we had done. (Can't remember the exact tests because it was a while ago. I do remember it being fairly comprehensive though.) He ended up telling me to take metformin, which did absolutely nothing, unless you count the part where it made me extremely ill. I haven't exactly been eager to go back to a doctor since...
posted by Scattercat at 8:01 AM on May 16, 2009

On various LC forums, I've seen a lot of people with thyroid problems have great success on low carb diets. But here's the thing -- this way of eating has a steep learning curve and it requires some research and work. It is NOT an intuitive way of eating for people raised on the FDA's vision of nutrition. And if your aim is to lose weight rather than feel better, you can't just cut out the refined sugars and grains and expect instant success.

For instance, you say your girlfriend eats fruit. Doesn't matter if the fruit is natural, it's still sugar. And some fruit's got way more sugar than others. So, if she's eating half a cup of raspberries a day, I'll agree that she's eating LC. If she's eating those raspberries plus an apple with almond butter in the afternoon for a snack, she's still eating LC but she's NOT eating the way LC-ers eat when they're out to lose weight. And if she's having a banana at breakfast, or snacking on figs, she's not eating LC at all.

Furthermore, I can't think of any LC diet -- other than perhaps South Beach in its later phases -- that could be described as high-fiber. (In fact, some people who eat LC eat this way precisely because they have digestion issues and DON'T want to eat a high fiber diet.)

Finally -- I REALLY can't think of any low carb diet that only gives you 1200 calories a day. LC diets are NOT low calorie diets. They don't work well as low calorie diets. If anything, they are moderate-protein, high-fat, relatively high calorie diets (two years ago, I, a late twentysomething woman, lost thirty-five pounds and got below my old high school weight while eating 2000 calories a day, on a diet that broke down like this: 60% fat, 34% protein, 6% carb).

If you try to make a low carb diet a low calorie diet, at best you will lose no weight. At worst, you will lose a great deal of weight *very* rapidly and unhealthily, and end up with some very bad side effects from it (arrhythmia, hair loss, blackouts).

So, I would ask you -- is she following an actual plan, or is she modifying one / following a plan of her own devising? If her aim is to lose weight, I think LC is one way to do it. But I would strongly recommend she pick a plan and follow it to the letter for a while. If she can't stomach the idea of high fat, she should try South Beach. If she wants total flexibility, she should try Life Without Bread. If she experiences low energy and cravings and wants to put an end to those, she should try Atkins, because the induction period is a craving-killer. If Atkins is a bit too insane for her but she likes the idea of starting out a bit draconian, she should try Protein Power. Here's a good comparison of those plans, and more.
posted by artemisia at 8:13 AM on May 16, 2009

Ooh sorry Scattercat, you posted as I was writing up. Okay, can I suggest you try something other than South Beach, then? I know it works for some people (my mother loves it), but I was never able to drop a pound on it (and it sounds like we're built very similarly, have the same "ideal weight" and activity level, etc.). SB is much less restrictive than some of the other LC plans; you're eating a whole lot more carbs on it than you would on, say, Atkins. In short, it might not be LC enough for you. The nice thing about Atkins, for instance, is that you start at a very low level and then slowly move up the carb rungs, so you can figure out exactly what level of (and type of) carbs it takes to lose/maintain for your body.

It's worth a try, at least!
posted by artemisia at 8:16 AM on May 16, 2009

Fatty deposits on the back of the neck is one of the classic symptoms of Cushing's Disease.
posted by Ruki at 8:30 AM on May 16, 2009

Sorry to hear about the doctor situation. Here's a list of endos and other thyroid doctors in VA, with comments from their patients. It's nice to get a sense before you bother making an appointment if he or she is the kind of doctor who will treat based on how their patients feel in addition to the numbers on the labs. Hopefully one of the good ones will be an option for you.
posted by katemonster at 8:42 AM on May 16, 2009

If you want to solve this issue, you need to just wage an all out war. That means: no excuses. Not saying you can't find an endocrinologist (if you live half-way between Richmond and DC, that means you're at least within 2 hours of an amazing doctor. There are endocrinologists ALL OVER the US.) And screw your fear of needles -- aren't you afraid of gaining 20lbs a year for the rest of your life? Plantar Faciitis? Then bike, swim, do Curves, etc. If you want to find an excuse for any part of this, you will. Instead, just tell yourself you will do ANYTHING to solve this problem. And then do it.

My guess is it's a compound problem:
- not getting heartrate high enough for long enough
- some sort of thyroid or metabolic or endocrinological problem. Low thyroid, Cushing's, bad blood sugars, polycystic ovarian syndrome (PCOS), who knows. Maybe a combination.
- not combining the right diet with the right exercise

So:
- get a trained nutritionist. If you have healthcare I bet there is one in your system. Starving yourself isn't helping and 1400 calories when you're used to eating more and exercising isn't a ton either. I think there is room for improvement here.
- go to two or three endocrinologists. Get your T3 and T4s and TSH tested separately. Look at PCOS.
- Don't self-diagnose - go in with all of your documented issues and let them figure it out but if you don't get an answer, FIND ANOTHER DOCTOR. Go to Richmond or DC if you have to. You have world-class doctors within a very short drive.
- get a trainer. For real. Not at a bad gym - with real credentials.
- get a journal devoted solely to this issue. Keep track of ALL tests and their results. Keep track of your diet and exercise. Then it's all in one place to bring with you.

I'm really sorry this is happening and you can't figure it out. I know from experience that health issues are really depressing and demoralizing. But on the bright side, it's in your power to figure it out - you just don't know what the problem is yet. Just make YOURSELF the promise that you will not take NO for an answer and you will do EVERYTHING you can to figure it out. No phobias, no excuses. I think you'll find that the confidence you gain in this will carry forward into helping yourself live the best life possible. Good luck!
posted by barnone at 10:10 AM on May 16, 2009 [2 favorites]

PS: there is a Diabetes and Thyroid Associates in Fredericksburg, VA. If you search Google Maps in your area I bet you'll find more. And call your insurance or look on their website - they'll have others listed in-network.
posted by barnone at 10:16 AM on May 16, 2009

Lot of thyroid posts lately. I'm just chiming in to say that her tests can be "normal" and she can still have thyroid problems. Last year, my preliminary tests were all in the normal range, but it turned out that I had thyroid cancer.
This happened to my aunt. Three rounds of blood tests for her thyroid, all normal. But because of her symptoms, her doctor still sent her to an endocrinologist for a scan. And that's how they found the tumor. (She was fine after surgery/treatment.)
posted by Oriole Adams at 10:35 AM on May 16, 2009

Not likely but she may want to get checked out forCushings Syndrome. What caught my eye was the unexplained and rapid weight gain, difficult weight loss, fatty deposits (particularly back of neck) and anxiety/depression. Hope you find the appropriate plan and diagnosis (if appropriate)
posted by rmhsinc at 10:48 AM on May 16, 2009

And to emphasize that it's definitely possible to be sub-clinical hypothyroid. Get your own numbers and do some research and talk to the docs. Do a search on AskMe for other thyroid questions.
posted by barnone at 11:15 AM on May 16, 2009

Just another data point to chime in that thyroid problems can most certainly still exist even when the tests come back in some sort of gray zone on the border of normal. Definitely go see an endocrinologist -- and be sure to see an endo who has extensive experience in thyroid disease. Some endocrinologists have most of their experience in managing diabetes and don't know how to deal with more complex or subtle thyroid issues (as I found out, to my frustration, for the first few years when I was trying to get my thyroid disorder properly diagnosed and treated).

You also might seriously consider ditching the birth control pills. Doctors -- even good ones -- are often weirdly clueless about the full range of side effects that hormonal birth control can cause. I swear to god, going off hormonal bc for good a few years ago solved, in the course of 2-4 weeks, about half a dozen low-level medical problems that had been bugging me for years.
posted by scody at 11:37 AM on May 16, 2009

I think you might be eating too few calories, like someone above suggested.

I use The Daily Plate to log what I eat. It has a calculator to figure how many calories you should be eating. I put in your height and weight, chose the options for losing 2 pounds a week and a moderate activity level, and it said you should eat about 2,000 calories a day. I think your body is going into starvation mode. I lost about 25 pounds a few years ago, and whenever I hit a plateau I would just eat a little bit more. It's counter intuitive, but it works.

It sounds like you are eating well, so try eating more and doing more exercise that gets your heart rate up. I am built similar to you (5'2", look best around 135) and I don't lose weight if I'm not doing vigorous exercise.
posted by apricot at 1:50 PM on May 16, 2009

Right, so I'm about her weight, but losing well on 1500cal per day - averaged over the week. It's been a month, so you can rule out issue with bloating during her period, so it's gotta be something else.

I think she's got enough data to go to her doctor and demand help to work out what's going on. An endocronologist is probably going to be useful too. These people are professionals, and do this for a living, so use them!

In the mean time, I would also suggest getting a heart-rate monitor and upping the intensity of her workouts to 75-85 percent of her maximum heartrate. Also throw in a higher calorie day every week or so to kick start her metabolism. (I got most of this from Jillian Michaels' podcasts - her new book may be useful) And if possible, try not to see this as defeat, but instead a puzzle to work out.
posted by kjs4 at 5:58 PM on May 16, 2009

Thirding the suggestion to look into Cushings disease. Find an expert in it, even if you have to travel to see them.
posted by fshgrl at 2:03 AM on May 17, 2009

The amazingly thorough Rachel at the F-word.org wrote a comprehensive series on thyroid issues a while back. Here is a post that links to all of the posts in the series. Best of luck figuring it all out--that doesn't sound fun, I'm sorry.
posted by eileen at 10:30 PM on May 17, 2009