My brain is broken.

November 25, 2009 2:25 PM

I think I may have a thyroid disorder. What now? Details inside.

25-year-old healthy white male. No medical history to speak of.

For the past five months, I have gradually lost my ability to concentrate or focus on anything for more than a few minutes at a time. (I have always been prone to distraction, but not like this.) My ability to process information has decreased, and I am constantly in a state of what can only be described as "brain fog".

I used to be quick-witted, but now I often will forget what I'm saying in the middle of a sentence. My conversational skills have tanked. I write a lot, but I go back and read the things I've written recently and they lack the clarity and cohesiveness that I used to have. I also fidget constantly. If I'm sitting at my desk, my leg is shaking almost 100% of the time. I am frustrated to no end with all of this.

The start of it coincided with a stressful project at work over the summer which lasted about 2 months. We also moved to a new city in October for my wife to take a job, and I am now working from home after being in an office environment for the past three years. So there were the factors of stress and and a big lifestyle change that could have contributed. It may be worth pointing out that I probably do not get as much exercise as I should, but I have recently started running a few times a week and it hasn't helped a bit. I also quit drinking coffee, but no help there either.

Most of these symptoms are indicative of a thyroid disorder of some sort (probably hypothyroidism). Both of my parents have had a history of minor thyroid problems so this would not be unprecedented, though they were both over 40 when they had their issues, so 25 is awfully young.

So I think I have a problem and I think I may know what it is. I'm scheduling my yearly physical in the next couple of days, and will see if I can get some tests done. (I am terrified that they won't find anything. The worst thing I could hear is that I don't have a problem.) But is there anything else I can do in the mean time? Any other steps I should be taking?

I know self-diagnosis is a dangerous thing, and I know hypothyroidism is an easy scapegoat for life failures. But I don't have anything to blame on it... I'm not overweight and I haven't really failed at anything. My work performance has actually been excellent despite all of this. I just can't think.

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

I think I may have a thyroid disorder. What now?

I'm scheduling my yearly physical in the next couple of days, and will see if I can get some tests done.

I don't mean to be snarky, and mods can delete away, but I really feel like you've answered your own question and now you are worrying. The better time to ask this question is after your appointment, that way you know what the tests said or didn't say, and what other possibilities there are.
posted by Think_Long at 2:31 PM on November 25, 2009 [3 favorites]

You certainly have *something*, which could be a thyroid issue or anxiety disorder. It sounds like you've gone through a lot of stress lately, which perhaps could trigger either.

Schedule that appointment and go. That's the best thing you can do right now.
posted by bluedaisy at 2:35 PM on November 25, 2009 [1 favorite]

You will take synthetic thyroid hormone if you have a thyroid problem. It's not a big deal, but you have to go get tested a lot which is a bit of a pain in the ass.

It could be any number of things, though, so try to relax and accept that you are a good person, a useful person, and you're still you no matter what is or isn't wrong with you.
posted by kathrineg at 2:47 PM on November 25, 2009

25 is awfully young.

No, not really. I was first diagnosed with thyroid issues in my early/mid-20s, and I know a number of other people (men and women) with thyroid problems who were diagnosed in their 20s as well.

(I am terrified that they won't find anything. The worst thing I could hear is that I don't have a problem.)

Having a test (or a series of tests) come up negative is not the same as being told you don't have a problem. It just means that the things they tested you for don't seem to be causing the problem. If your thyroid tests come back normal, you simply ask your doctor what the next step should be.

In the meantime, the most useful thing you can do is to try to set aside the catastrophic storytelling about future worse-case scenarios ("I am terrified of what might happen..." "the worst thing I could hear is...") and just stay focused on concrete steps: you are seeing a doctor, and will request thyroid tests. When the test results come back, you and your doctor will go from there. That's it. Whatever happens, you can handle it.

But is there anything else I can do in the mean time? Any other steps I should be taking?

Schedule your physical as planned. There's really nothing else to do except sit tight and try to stay calm and to be good to yourself. You sound pretty anxious, so maybe consider cutting back on caffeine and trying to get enough sleep and exercise in the meantime.
posted by scody at 2:49 PM on November 25, 2009 [2 favorites]

Also, I have to say that the fidgeting plus the brain fog might be an ADD thing that is made worse by lack of sleep, stress, a distracting environment (home)
posted by kathrineg at 2:49 PM on November 25, 2009 [1 favorite]

(sorry, I missed the part about where you said you'd already quit drinking coffee. As for exercise, if you're not getting anything out of running, maybe try something else that will engage you mentally in a different way -- for example, is there a Y with a pool near you? Any interest in yoga?)
posted by scody at 3:01 PM on November 25, 2009

I wouldn't worry too much. Definitely talk to your doctor about it. You'll get a blood test that will tell you fairly shortly if you have any thyroid problems. If you don't, you might have depression, ADD, or a similar disorder. It's good that you have a doctor's appointment coming up, as you can talk to him about whether or not you have these problems.
posted by mccarty.tim at 3:01 PM on November 25, 2009 [1 favorite]

Read up about what the normal range of T3 levels is supposed to be because it has changed and some doctors still use the old scale. Most doctors will not advocate thyroid hormone replacement if you are borderline unless you request it, which is why you should be aware of the normal range. If you are borderline just tell your doctor that you'd like to try to see if it makes a difference since there's hypothyroidism in your family history.

When I was diagnosed with hypothyroidism (family history as well) 2 years ago my thyroid was barely working, but now I take a tiny amount of Levoxyl to keep me in the normal range. I'd recommend the brand name Levoxyl over any generic as well should you need to take medication to treat hypothyroidism. There's not much if any price difference. A month's supply without insurance ranges between $10-20. And unless you're body is way outta whack you should just have to have blood tests every 6 months or so. No big deal. Just remember to take your pills. I still often forget.
posted by wherever, whatever at 3:02 PM on November 25, 2009

A couple of things.

First, be persistent with your doctors. The guidelines recently changed to include more people as hypothyroid. If your TSH is between .5 and 5.0 you are considered "normal." Paradoxically, the *higher* your number the more you need to take thyroid medication. Most doctors try to medicate down to 1.0-2.0. Most people feel best when their thyroid is down around 1.0, so if you are at the higher end of the range, push to have a trial period taking medication. The symptoms you are describing largely go away if you get on the right dosage, but be prepared for blood work every three months or so while you get dosage sorted out.

Second, although you only mentioned it in passing, working from home is huge. When I first started working from home, I experienced many of the same symptoms you describe. Reading the article linked in this post made me realize that I was isolating myself from people and experiencing many of the effects of solitary confinement. Since March, I have been working at least one day at a coffee shop or bookstore and it has made a remarkably difference in my life. I am not as lethargic, sentences are easier to finish, and I'm not having trouble locating words anymore. I don't even talk to people (except to order coffee) when I'm out. Just seeing them makes all the difference.
posted by stoneweaver at 3:09 PM on November 25, 2009 [1 favorite]

wherever, whatever: Thanks for pulling my real question out of there... I guess I was asking what I could do in the mean time to be prepared, and what to expect, but that was not at all clear in the original post. Much appreciated.

stoneweaver: Very helpful information, also appreciated... as I said, no medical history, so I've never had to deal with prescriptions before. If my tests came back borderline and the doctor said no medication, I probably would have accepted it and been miserable. I didn't realize I could have some say in the matter. I will keep that in mind...
posted by relucent at 4:08 PM on November 25, 2009

If you really believe you have a thyroid problem, request a TFT Panel. Without going into great detail, many doctors only do what's called a "thyroid screen." Here's what usually happens: If the doctor orders a screen and it turns up negative, and you're showing symptoms of thyroid dysfunction, they'll turn right around and "just to be sure" order the other tests. It should be done right the first time. It's almost scandalous how many doctors rely on the screens as opposed to ordering a full TFT panel.

With the above said, I would strongly encourage you to keep an open mind about the way stress and anxiety take a toll on our cognitive functioning. You describe a textbook scenario for cognitive dysfunction in your paragraph describing stress at work, moving to a new city, and now working from home. Any one of those alone could cause the symptoms you describe.

Here's to you finding some answers - and to your good health - Good luck!
posted by Gerard Sorme at 4:15 PM on November 25, 2009 [3 favorites]

All of your symptoms are associated with common psychological problems that people have in their mid twenties while they are in stressful situations. ADD, anxiety, and depression are all possibilities. They have symptoms identical to the ones you are describing. I'm not really sure why you decided to jump right to hypothyroidism diagnosis, even with the family history. It's totally alright to have some relatively mild psychological problems. It doesn't mean you are making excuses or anything. It really sounds like you are obsessing over this and perhaps even avoiding or at least overlooking a psychological cause.

I've been an anxious person my entire life. All through highschool and college my mild anxiety was actually a bit helpful. I got work done, noticed all the details, and didn't need caffeine breaks. However, in grad school at the age of 24 my anxiety started to get subtly out of control. My life was perfect but my writing ability declined, I started missing details, and I started questioning my abilities. It was hard for me to pick up on the anxiety increase because I was so busy and paranoid. A brief stint on an SSRI is what I needed.

I'm a bit concerned that you are going to excessively fight any negative hypothyroid test results. You don't have to be miserable about a negative diagnosis because that will simply suggest that your problem may be psychological.

By the way if your problem is anxiety, a drug that cranks up thyroid activity is probably the last thing you want to be on.
posted by Procloeon at 4:55 PM on November 25, 2009 [1 favorite]

I recommend reading this page and clicking around that site. As mentioned above, there was a recent change in the 'normal' range for the most common test. But some doctors don't even trust that single test to accurately diagnose thyroid problems. I'll second Gerard Sorme's recommendation to request the panel.

Also, depending on how things go with your doctor, you can visit this community to find help and information from others who may be going through the same thing as you. If your doctor tells you that you are 'fine' and there's nothing medically wrong with you (but you aren't convinced), that would be a good place to get more help.

To answer your specific question about what you can do, you can regularly take your temperature and log it. As that page says, it can be a clue to your metabolic health.
posted by ghostmanonsecond at 5:04 PM on November 25, 2009

I've had hypothyroidism for about ten years now (since I was 18), and you've definitely described some of the major symptoms (brain fogginess/dullness, inability to focus). I haven't been seeing a doctor or taking my meds for a few years, and all of those symptoms have returned in full force. I can barely focus to blog or even write coherent Mefi comments anymore! Have you experienced any physical symptoms of hypothyroidism? These may include inexplicable weight gain (or the inability to lose weight), feeling cold all the time, constipation, fatigue, uncharacteristic napping or nodding off, hair loss.

The best thing to do before your appointment is to read up on hypothyroidism. Know a bit about the symptoms, the tests, the treatments, and the drugs that are typically (and not as typically) prescribed. Go in to your appointment: 1) with a full list of symptoms, 2) knowing what you want the doctor to test for, and 3) with any questions you might have. Here's some thyroid reading that you may or may not have found: Thyroid Info, Hypothyroidism at EndocrineWeb. I wish that I would have had more control over the beginning of my thyroid treatment. I was young, and I didn't know what was happening to me. I didn't ask my doctor anything, and I didn't question the tests he gave me and the medication he eventually put me on (Synthroid).
posted by Mael Oui at 10:08 PM on November 25, 2009

Read this article by a fairly respected cardiologist, you'll probably want to supplement your diet with something containing iodine, for example kelp.
posted by zentrification at 8:22 PM on November 26, 2009