Help me justify putting off a visit to the doctor because I am poor.

August 24, 2009 11:01 AM

Another thyroid question...

So me-fites...help me figure out if I should go to the doctor or not. Typically I would just go anyway, but I just got my very own brand new shiny health insurance and I haven't yet met my $400 bubble where insurance starts paying for stuff. I have been experiencing some symptoms that would indicate hypothyroidism. They include:

- I feel like my hair is falling out at a more rapid rate than it used to. In sunlight I can see through to my scalp, which has never been the case in the past. I am also getting split ends and my hair breaks really easily. I never. Ever. EVER had split ends in the past, even when I was heat styling my hair almost every day and getting my hair cut once a year. Now I always let my hair air dry, and get a trim every 3 months and still, split ends galore.
- My nails (which were also super duper strong and unbreakable once upon a time) now break much more easily, and start peeling as well from time to time.
- I have had eczema since a child, but for the first time in my life I am getting patches of eczema on my face in the summertime.
- Extreme daytime fatigue, even after changing my diet to include more healthy foods, upping (and lowering) my food intake, going to bed earlier, etc. I pretty much can't help but pass out after I get home from work.
- I was sleeping pretty well every night up until a couple of months ago when I started having more and more frequent bouts of insomnia. The fatigue has been present a lot longer than the insomnia, by a couple of years at least, though now I'm sure it's attributable to the insomnia.
- Unending low grade depression
- Unexplained joint pain. I have flat feet, so if I'm on my feet for a significant amount of time, my ankles/knees/hips/lower back will ache, but often I'll have had a low key day and I still end up feeling arthritic (I'm only 23).
- Constipation
- A once laid back person, I am now more prone to snap at my loved ones in anger when they don't deserve it. I would now classify myself as having a hot temper.
- I had blood work done 2 years ago to test TSH, and mine was at 4.3. My doc said it was on the high side of normal but still within normal range. I got tested again a month after that, and all was back to well within normal ranges.
- Perhaps the most frightening symptom of all is the memory loss/brain fog. I have trouble recalling simple words when speaking and my ability to compose sentences has gone down the shitter. I find myself being grammatically incorrect a lot, but can't think of the proper way of how to phrase things. I was once a star english student and used to pride myself on my vocabulary. I feel like I've been dumbed down by 30 IQ points. I have so much trouble trying to focus my brain at work, but can't remember all the tasks I need to complete.

I know there are other symptoms that I am simply not recalling at this moment in time.

Now I know you're saying, get thee to a doctor, stupid! What perplexes me, and the reason why I am asking this question, is that I am not overweight. I gained weight (15 lbs) when I started college 5 years ago that I didn't lose (lack of exercise, horrible diet) until this past year, when other health issues caused me to be unable to eat my typical diet, or much of anything at all. I now have a healthier appetite (and am making much wiser food choices) and have gained a couple of lbs back, but nothing major.

I have a family history of my paternal grandmother and an aunt (her daughter) having hypothyroidism. It should be noted that they have always been pin-thin before and during their hypothyroidism (but perhaps may be due to their penchant for eating disorders). I am not close with them, nor do I wish to be, so talking to them about this is not an option.

So. Given the symptoms above, and seeing as how some of them may be explained away by other things, and also seeing as how my weight is under control, do I need to see a doctor immediately or soon? I will go if it seems like I need to, or eventually, but money is tight and like I said, insurance bubble (whatever the fuck it's called, I can't remember) hasn't been reached yet so any visit I make will be paid for out of pocket. Have any of you ever experienced or heard of hypothyroidism sans weight gain? If I do have hypothyroidism, will delaying a doctor visit by 3-6 months make a difference?

Also, I noticed today while touching my neck that my thyroid may be swollen? I don't really know what my baseline is, so I'm not sure if it is swollen, or how to judge. I tried googling "how to identify swollen thyroid" and found one video that wasn't particularly helpful. If I tilt my head back, I can see it sticking out from my neck. While I was thinking about it, I also started remembering that for the past couple of months or so, things have taken a couple or a few swallows to get completely down. Maybe it's in my head, I don't know...but do you have any tips for feeling up your thyroid? What should I be looking for?

posted by Gonestarfishing to health & fitness (15 comments total)

Here's the thing: you might not have hypothyroidism, you might have something else. We really don't know. Those things might not affect your weight. So you're trying to use the lack of one symptom to prove that you don't have one disease; problem is that you could have something else. Other autoimmune disorders come to mind because of the arthritis but I really have no clue. You haven't even had any blood tests!

Anyway, I suggest going to a doctor. You're going to have to spend the $400 anyway, right? Might as well get it over with, put it on a credit card, and get some help.

They should do more thyroid tests than just the TSH, by the way.
posted by kathrineg at 11:23 AM on August 24 [2 favorites has favorites]

Plenty of people with hypothyroidism or Hashimotos are not overweight (or even average weight). Also, the "new normal" for TSH is .3-3.0.

If this is your problem, or part of your problem, you'll feel a lot better with treatment...and the medication is dirt cheap (approx $5/month).
posted by availablelight at 11:33 AM on August 24

Second, third and fourth opinion. All the people I know who have thyroid issues are normally more informed than most general practitioners are. If your general practitioner is getting nowhere maybe go see an endocrinologist.
posted by ian1977 at 11:36 AM on August 24

It sounds like your symptoms are causing you some concern, which is a good reason to go see a doctor, finances aside. If you and your doctor do decide that you are hypothyroid, the treatment is easy and effective (well, as easy as taking a pill a day can be).

I will say from personal experience that hypothyroid symptoms are not all or nothing: I have some of the classic symptoms but certainly not all of them. I wouldn't use NOT having one symptom as a reason to not get your health checked out.

I can't speak to whether or not delaying a doctor's visit will cause you harm, but if you know you're going to meet your deductible sooner or later, why not get it over with now and address your health concerns?
posted by gingerbeer at 11:37 AM on August 24

I was first diagnosed of hypothyroidism at a very skinny 13. You don't have to be overweight.
If your are hypo, how it affects you varies -- every person's different. My first symptom was a goiter, for example. If that's what you have -- trust me, you'll know. You won't have to go looking for it.

But if it's bothering you, get thee to a doc. You'll be spending the $400 eventually anyway. As for the 3-6 month wait, well -- why chance it? For example (and I realize you're well past your growing years), but it has been noted I'm about an inch or so shorter than I should have been had I had known and dealt with my thyroid issues earlier as a kid. Messing with your hormones is, well, messy.
posted by cgg at 11:51 AM on August 24

All the people I know who have thyroid issues are normally more informed than most general practitioners are.

Yes, and the GPs hate it!

Make them give you full TSH, free T4, and free T3 tests, and make them give you the numbers! Do not settle for "oh, you're fine/normal"!
posted by jgirl at 11:53 AM on August 24 [4 favorites has favorites]

You don't have to have every symptom of hyper- or hypothyroidism to be hyper- or hypothyroid. My mom is heavy and is (counterintuitively, if you go by symptom list alone) hyperthyroid. Before I had my thyroid out due to cancer, I was thin and (counterintuitively) hypothyroid.

If you're not getting anywhere with your GP, see an endocrinologist. (And try to see one who has a speciality in thyroid issues, and not just diabetes. My cancer diagnosis was delayed by at least a year due in part to an endocrinologist who almost exclusively handled diabetes cases and who had very little familiarity with thryoid disease.)
posted by scody at 12:05 PM on August 24

Can't help you here, man. The symptoms say: Go see a doctor.

(There should be a common-use acronym for this, I think. "GSAD", perhaps?)
posted by Citrus at 12:16 PM on August 24

As far as the finances go, there is no-one in the world easier to set up a payment plan with than a doctor's billing office. We have good insurance but we are always needing to spread out the payments for our deductible and co-insurance, and it's never a problem. If you feel like going to the doctor is a good idea--and I'd endorse the idea that it is--it's very unlikely that they'll ask you to pay the full fee at the appointment. You'll pay your co-pay, if you have one; the office will bill your insurance; your insurance will send you and the doctor an EOB saying, "Oh, hey, look, we applied this to the deductible"; the doctor's office will send you a bill; you'll call the billing office and say, "Hi, I have a bill here and I'd like to set up a payment plan," and they'll say, "OK, how much can you afford per month?" and you'll say, "Um, $20?" and they'll say, "OK, great!"
posted by not that girl at 12:27 PM on August 24 [1 favorite has favorites]

As mentioned earlier, the new 'normal' range for TSH is 3.0. My doctor considers anyone with a TSH above 1.5 AND with hypothyroid symptoms as being hypothyroid and needing treatment (from what you mention, you would definitely qualify as having symptoms). I was hypothyroid and did not gain weight. You should see a doctor, but you may want to spend some time finding one that you know will be more open minded about diagnosing thyroid issues than most conventional doctors. You might want to spend some time on this site.

I was hypothyroid for years and had many doctors tell me that there was nothing wrong with me. I finally convinced myself that they were wrong. I found a doctor who diagnosed me, started treatment, and immediately started feeling much better.
posted by ghostmanonsecond at 12:34 PM on August 24 [1 favorite has favorites]

ghostmanonsecond, I want to see your doctor! My doctor still thinks TSH above 3.x, even with symptoms, is normal. He's great in all other aspects of my care, but he still goes by the old TSH ranges.

To the OP, see a doctor. I have hypothyroidism and gained weight, along with a slew of other symptoms. My grandmother has been thin her entire life and also has hypothyroidism. She said that before she was given treatment, she only had a couple of symptoms, and even then she didn't really notice them - the doctor found her diagnosis through routine blood tests. You could be hypothyroid or you could have any number of other conditions, but going to the doctor is really the only way to find out.
posted by bedhead at 1:12 PM on August 24

Don't put it off, OP! You will just feel worse.
posted by jgirl at 1:44 PM on August 24

Classic hypothyroid. Spend the money, it's worth every penny, plus the meds don't cost much at all..... makes all the difference in the world getting diagnosed! Go girl to thy physician!
posted by ~Sushma~ at 6:02 PM on August 24

I second what most everyone says here:
-I esp second what was said by jgirl, get a TSH, free t4 and free t3 test done. Your body could be making all the right hormones but if you're not absorbing them right, it doesn't matter.
-Go see an endocrinologist if you can, instead of a gp.
-talk to whichever endo you choose and make sure he or she agrees that a TSH above 3 or 5 might not work for you.

I was at a TSH level of 5 for years and I was taking synthroid and it never got any better, until I found a doctor who brought it down to 1 or so. I feel soooo much better now. It took some adjustment (I was hyper for a while) but it was so worth it.

I also suggest reading Living Well with Hypothyroidism by Mary Shomon. This book helped me so much in understanding my hypothyroidism and finding a good doctor, even eating the correct diet. It also deals with the different types of meds for hypo, which you will definitely need to know if diagnosed so.
posted by Polgara at 6:51 PM on August 24

Many of your symptoms (certainly joint pain, fatigue, and memory loss/brain fog) are indicative of Lyme disease. It is an often misdiagnosed disease and if left untreated can become seriously debilitating. I would highly recommend finding a lyme literate doctor (LLMD) as many doctors seem to dismiss lyme disease with a wave of their hand.

http://www.ilads.org/
http://www.turnthecorner.org/
http://www.lymediseaseassociation.org/
posted by quinncom at 1:53 PM on September 11