I'm not fat and lazy, it's metabolic?

April 18, 2008 5:28 AM

MedicalSymptomsFilter: Hypothyroidism or something else?

Phew, so here's the deal: I've been gaining weight rapidly over the last 6 months, to the tune of just under 30 lbs so far, with no changes in diet or excerise regime (if anything I'm eating better than I was and moving more). My starting weight was 120 so that's a significant increase. I booked an appointment with the Student Health clinic at my school, which can be described as lackluster at best, in which the doctor asked a few questions about fatigue and my ability to tolerate cold and based on my answers, coupled with a reflex tests of my arms, wrists and kness, informed me I'm likely developing hypothyroidism. He ordered bloodwork, told me to wait for the call and sent me on my way. No call. So I called them and was informed by a nurse that all my levels were "normal". I was a bit confused by this and went to the Mayo Clinic's website to do a little more research about hypothyroidism. Of the 12 symptoms listed on this page, I have 11. I don't know about my blood cholesterol level, it's never been checked ASAIK.

I've already made another appointment to see the same doctor, I have no family doctor and none in my area are accepting new patients so I don't know where to go for a second opinion, but I just wanted to the ask the MeFites if there's something else that can cause those symptoms? Is it possible to have hypothyroidism with "normal" bloodwork? I do plan on asking the doctor to go over my results with me, and to make sure they're mine (results get mixed up quite a bit in this clinic, at least that's the rumour) but is there something else I can/should ask him about? In the meantime, I'm going crazy thinking about this, I hate when stuff is "broken", especially when it means that my pants don't fit :/

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

Hrm, that's supposed to be AFAIK...
posted by LunaticFringe at 5:31 AM on April 18, 2008

I had read recently that, in the US, ‘normal’ is in the process of, or already has been redefined. Your doctor may not know about this recent redefinition so get your results for yourself and do a little research.

There is a lot of bad information out there for people in your position but a lot of the websites for hypothyroidism can give you the names of doctors who have better reputations for dealing with the problem. The different answers to the questions you are asking are controversial - particularly when someone is in the normal range but has all the symptoms.

Finally, there is another issue that often crosses into the ‘new age’ arena of understanding which is called ‘adrenal fatigue’ or exhaustion. Again, there is a lot of bad info out there but the symptoms overlap. Some people who are in the normal range for thyroid have gone this route to find productive solutions.

Good luck in sorting things out. It’s crap being where you are right now and if you are hypo you will be amazed by the benefits of thyroxin.
posted by anglophiliated at 6:04 AM on April 18, 2008

Your student health center probably has several doctors. Ask around among your fellow students and find out who the good doctor is. At my student health center, the wait for appointments with the good doctor is a month (but you can get appointments the day of with the doctors who go through the list 1)pregnant, 2)mono, 3)depressed). The good doctor will at least take your concerns seriously, probably rerun the tests, and then explore other possible diagnoses.

If the general consensus on campus is that there isn't a good doctor at student health, ask your current doctor for a referral to a specialist. With hypothyroidism, the obvious specialist is an endocrinologist but with your joint pain you could also try a rheumatologist. The wait for the specialists may be more than a month, but they will at least take you seriously.
posted by hydropsyche at 6:11 AM on April 18, 2008

IANAD, but your symptoms sound very similar to mine the year that I developed insulin resistance, also called metabolic syndrome when other factors are present. Sudden onset weight gain, normal thyroid, doctors just kept telling me to eat less/exercise more.

Several years and over 50 pounds later, after finding the right doctor, I learned I was eating the wrong stuff. To simplify: people with IR can't tolerate carbs very well, but thrive on proteins and fats. By switching to a high-protein, controlled-carb diet, I dropped 50 pounds and got my energy back (and have kept the weight off for over 5 years now).

How's your diet? Do you eat a lot of fast food or processed food? Do you drink soda? Do you follow the low-fat dogma? If so, you might want to try cutting all of that stuff out, making protein the cornerstone of your diet, and being more liberal with healthy fats, such as those found in fish, nuts, and olive oil. Bottom line, the standard Western diet - what we here in the US think of as a "normal" diet - is about the worst thing someone with IR can eat.

Wishing you good luck in getting this resolved. I know from experience how hard it can be when you *know* you have a problem, but your standard labs are all "normal" and you can't get the help you need.
posted by chez shoes at 6:23 AM on April 18, 2008 [1 favorite has favorites]

for years a TSH level under 5 was considered normal. in 2002, the american association of endocrinologists released revised guidelines, and recommended treatment for TSH levels of anything up to 3. in my experience most non-specialists don't know about this. i would get a copy of your lab results, see what the TSH level is, and if it's appropriate, see a specialist.
posted by apostrophe at 7:01 AM on April 18, 2008 [1 favorite has favorites]

I just wanted to the ask the MeFites if there's something else that can cause those symptoms?

cushing's syndrome

not saying you have it, but it does cause rapid weight gain.
posted by brevator at 7:36 AM on April 18, 2008

hydro: Luckily, I am seeing the "good" doctor, the last one I went to told me I just needed to watch my diet and exercise. I don't make appointments with her anymore. I was also thinking of asking to be referred to a specialist, although the waiting lists here are enormous and it can take months to get an appointment. I'll add it to the list though :)

chez shoes: My diet is pretty good but not the best. I do eat fast and processed foods but not more than once a week. I also have about a can of soda a week. I don't really like it so I don't drink it often. I do often crave fats, like cheese or mayonnaise but have been trying to eat less of these as initially I thought it was my diet that was causing the weight gain. I'm gonna ask this guy if he thinks IR could be a concern. Grats on the weight loss, btw :)

apostrophe: I'll mention this to him and be sure to get a copy of my results.

brev: added to my list, scary, but thanks!

Thanks for all the responses so far! I'm making a list of things to bring up with him so that I don't forget anything during the appointment.
posted by LunaticFringe at 7:38 AM on April 18, 2008

Agreeing that "normal" might not be optimal for you. I believe that the "normal" values are more like "average" values, and they somewhat arbitrarily pick points on the bell curve as thresholds for treatment.

Diet can be corrective, however. Doing things like eating your biggest meal in the morning and smallest meal in the evening, and switching to a high protein, low fat and low carb diet might be helpful. Learn about the glycemic index of carbs, and try to make choices that are on the good end of the spectrum.

Also learn how to read labels- many products labeled as "low carb" or "whole grain" may not be.
posted by gjc at 7:59 AM on April 18, 2008

Another thing: with IR, or Cushing's Syndrome for that matter, oftentimes the weight gain will be primarily through the midsection - what is sometimes called an "apple-shaped" body (as opposed to pear-shaped, where the weight gain is in the butt!).

So your weight gain pattern, if there is one, might be one clue for the doc to follow.
posted by chez shoes at 8:08 AM on April 18, 2008

Just want to add to the responses saying that "normal" is a range and an individual's optimal point may be at different places within that range. I am hypothyroid as are 2 of my closest friends. One friend is doing absolutely fine with a TSH slightly above the new AACE limits; the other has symptoms that are only mitigated by keeping her TSH below 1.5. I happen to fall somewhere in between (about 2.5).

If you are still not satisfied with how you feel, would it be possible for you to request a referral to an endocrinologist for a more complete endocrine work-up? (Sorry, don't know how the Canadian medical system works.) It's my experience that a specialist is a better option for fine-tuning treatment if you need it.
posted by weebil at 9:11 AM on April 18, 2008

Seconding chez shoes. There are a lot of people out there with symptoms similar to yours who have insulin resistance, and for whom the standard prescribed American diet of low-fat everything does more harm than good. As you're trying to get an appointment with another doctor, try for a week to cut out flour and sugar from your diet and eat proteins and fats. You might be surprised.
posted by peacheater at 9:14 AM on April 18, 2008

Two cents. The initial lab test for hypothyroidism is for TSH, which is actually a pituitary hormone sent to the thyroid to trigger production. It catches 80-90% of cases, but if that's the only test done so far, please know it can be fallible, and is suspect in the presence of physical symptoms of hypothyroidism. If either the pituitary or hypothalamus is failing to send the signal to the thyroid, your TSH will measure normal (or even low) while your thyroid levels keep dropping.

If you have the symptoms of hypo, yet the initial tests are inconclusive, you may want to request that free T3 and free T4 be measured. These are the two major thyroid hormones. "Free" is important here; you want the unbound and available hormones tested.

Pituitary and hypothalamus involvement are called secondary and tertiary hypothyroidism respectively. Yep, they're "rare". Yes, they happen in males and females. If you and/or your doctor suspect either of these, you will want to test and treat your adrenals BEFORE beginning thyroid replacement hormones.

How did I learn this? I had to, mainly because a top endocrinologist 20 years ago repeatedly said that my blood work was impossible. Feel free to MeFiMail me.
posted by vers at 2:51 PM on April 18, 2008

Agree that your "free T4" level will help clarify this.

For TSH, like most blood tests, there's no such thing as "normal". There is a "reference range" which is the middle 95% of values in apparently healthy people.
posted by neuron at 3:41 PM on April 18, 2008

LF - even if, by some metric, you are felt to be Hypothyroid, the reasons for your weight gain will not likely be accounted for by an underactive thyroid, simply because it rarely has that huge an impact on a person's weight. Barring some extremely esoteric source for your concerns, the likely outcome here is you are going to need to do a wholesale review of your diet and exercise routine. And frankly, low-fat was never meant to be carb-heavy. Eat a diet high in whole foods, treat fast food like sex with a Haitian prostitute, soda is a suckers game, and get to the gym, and start eating and drinking from child-size plates and glasses.

From your info, you say you've gained about 30 lbs over 6 months, so approx. 5 pounds a month. At 3500 kcal per pound, that's around 18000 calories a month excess over your needs or around 500 calories a day. That's like 3 containers of yogurt or less than a cup of raisins or an Egg McMuffin a day, which is pretty easy to put away over the course of a day unless you are really, really tracking your input and being consistent in your habits.

By all means look into the endocrine angle, but think as well about the far, far more common outcome. All of us have a certain set-point for weight that increases as we age. You may be seeing that in action earlier than you would have liked to.
posted by docpops at 6:29 PM on April 18, 2008

For those that are following: Was informed that my TSH was 1.6 and T3/T4 was "normal" so I'm off to an "internal medicine" specialist (apparently this includes endocrinology...) as soon as an appointment can be made. This Dr. is nice and has yet to inform me it's "in my head", instead he's eager to figure out what can be causing my symptoms. Secondary or tertiary hypothyroidism have not been ruled out...
posted by LunaticFringe at 8:46 AM on April 29, 2008